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A 


DESCRIPTIVE  CATALOGUE 

OF  THE 

ANATOMICAL  MUSEUM 

OF  THE 


BOSTON  SOCIETY  FOR  MEDICAL  IMPROVEMENT. 


BY 

J.  B.  S.  JACKSON,  M.  D. 

CURATOR  OF  THE  MUSEUM;  PROF.  OF  PATHOLOGICAL  ANATOMY 
IN  HARVARD  UNIVERSITY. 


BOSTON: 

WILLIAM  D.  T1CKNOR  AND  COMPANY. 


1847. 


^ac  krso-Q 


BOSTON . 

PRINTED  BY  FREEMAN  AND  BOLLES, 
DEVONSHIRE  STREET 


INTRODUCTION. 


The  Boston  Society  for  Medical  Improvement  was 
founded  in  tlie  year  1828,  and  has  continued  its  meet- 
ings regularly,  twice  a month,  to  the  present  time.  At 
these  meetings  an  original  paper  is  usually  read  by  one 
of  the  members  in  turn ; and  each  one  present  is  called 
upon  to  communicate,  extemporaneously  or  in  writing, 
any  information  or  cases  of  interest  that  may  have  oc- 
curred to  him  during  the  interval  of  the  meetings,  or 
any  case  concerning  which  he  may  desire  to  have  the 
opinion  of  the  Society ; each  member  thus  obtaining 
direct  information  in  regard  to  most  of  the  important 
cases  that  have  occurred  in  the  city  or  vicinity.  These 
Proceedings  are  fully  recorded  by  a Secretary,  who  is 
annually  chosen;  and,  the  same  course  having  been 
pursued  from  the  first,  they  now  amount  to  several 
volumes.  » 

As  the  community  is  in  general  favorably  disposed  to 
the  practice  of  post-mortem  examinations,  the  reports 
of  fatal  cases  are  frequently  accompanied  by  the  dis- 
eased parts ; and  hence  the  subject  of  Morbid  Anatomy 

24428 


IV 


INTRODUCTION. 


has  always  received  from  the  Society  a large  share  of 
attention.  From  a selection  of  the  specimens  thus 
exhibited,  the  Cabinet  of  the  Society  has  been  mainly 
formed,  and  its  peculiar  and  principal  interest  is  due  to 
the  connection  of  the  specimens,  in  most  instances,  with 
authentic  histories  of  the  cases  from  which  they  were  de- 
rived. Some  very  important  specimens,  however,  have 
been  obtained  from  other  sources ; and  the  donations  of 
Dr.  Robert  W.  Hooper,  one  of  our  members,  and  of 
Prof.  Nathan  R.  Smith,  of  Baltimore,  deserve  an  espe- 
cial notice.  The  collection  of  Chinese  Paintings,  pre- 
sented by  Dr.  Hooper,  with  the  nearly  complete  history 
of  the  cases  that  he  has  been  able  to  obtain,  form  a rich 
series  of  illustrations,  far  more  valuable  than  any  pre- 
served specimens  of  disease,  and  which  nothing  could 
equal  but  an  examination  of  the  patients  themselves. 
The  suite  of  casts  presented  by  Prof.  Smith  is  also  a 
very  important  acquisition  to  the  Cabinet  of  the  Soci- 
ety ; this  donation  was  made  at  the  suggestion  of  Dr. 
J oseph  Roby,  who  now  holds  the  Professorship  of  Anat- 
omy at  Baltimore  as  a colleague  of  Prof.  S.,  but  who, 
for  many  years  before  he  left  this  city,  was  one  of  our 
most  active  members  ; the  value  of  this  collection,  how- 
ever, to  the  Society,  would  be  much  increased  if  accom- 
panied with  a history  of  the  individual  cases.  There  is 
also  in  the  Cabinet  a large  collection  of  gunshot  inju- 
ries of  the  bones,  with  some  other  specimens,  which 
were  presented  several  years  since  by  Dr.  S.  D.  Town- 
send, and  were  obtained  mostly  at  the  U.  S.  Marine 


INTRODUCTION. 


V 


Hospital  in  Chelsea,  during  the  war  of  1812  ; many 
diseased  bones,  with  some  national  skulls,  have  also 
been  presented  by  Dr.  Charles  H.  Stedman,  who  for 
some  years  held  the  office  of  physician  at  the  same  Hos- 
pital, the  specimens  in  both  of  these  collections  being 
accompanied  with  their  histories  ; some  fine  specimens 
of  diseased  bones,  and  several  very  beautiful  anatomical 
preparations  and  models  of  disease  were  purchased  by 
Dr.  George  C.  Shattuck,  Jr.,  when  in  Paris,  and  these 
have  since  been  presented  by  him  to  the  Society. 

In  the  written  Catalogue  of  the  Cabinet,  which  is 
much  more  in  detail  than  the  present  volume,  the  spe- 
cimens are  entered,  described  and  numbered,  in  the 
order  in  which  they  are  received,  and  the  correspond- 
ing number  is  placed  upon  the  specimens.  There  is 
also  an  index,  in  which  each  specimen  is  at  the  same 
time  entered  according  to  a scientific  arrangement,  very 
similar  to  the  one  here  adopted. 

The  funds  of  -the  Society  being  very  limited,  those 
specimens  only  have  been  preserved,  as  a general  rule, 
that  were  interesting  in  regard  to  the  history  of  the 
case,  or  to  some  point  of  general  or  morbid  anatomy, 
many  of  those  which  are  exhibited  at  the  meetings  being 
excluded  because  of  the  frequency  of  their  occurrence, 
and  many  others  from  a want  of  some  means  of  preserving 
the  anatomical  appearances.  The  Cabinet,  for  example, 
does  not  contain  a common  case  of  tuberculous  lung, 
and,  on  the  other  hand,  when  a carcinomatous  testicle 
was  recently  added,  it  was  in  consideration  of  the  age 


24428 


VI 


INTRODUCTION. 


of  the  subject,  and  not  with  any  idea  of  showing  the 
anatomical  appearances  of  the  disease,  which  were,  as 
usual,  almost  entirely  destroyed  by  the  preservative 
liquid. 

Several  years  ago,  it  was  proposed  to  publish  the 
Catalogue  of  the  Cabinet,  and  the  idea  having  been 
favorably  received,  the  necessary  funds  were  at  once 
collected  by  private  subscription  amongst  the  members 
of  the  Society.  The  work  could  and  should  have  been 
prepared  at  Once,  and  an  apology  is  due  to  the  Society 
for  the  long  delay  that  has  ensued ; but  it  is  some  com- 
pensation to  know  that  the  Cabinet  contains  many  more 
specimens  than  it  did  when  the  publication  was  first 
thought  of,  as  it  is  a source  of  regret  to  publish  the 
Catalogue  even  now,  when  such  constant  accessions  are 
being  made.  The  collection  is  still  small,  but  it  is  be- 
lieved to  contain,  in  proportion  to  its  size,  very  many 
rare  and  valuable  specimens.  Some  are  regarded  as 
new  to  science,  whether  in  morbid  or  general  anatomy, 
or  as  opposed  to  opinions  generally  received ; but  of 
this  others  will  judge,  who  have  more  extended  means 
of  observation  than  we  possess. 

The  division  of  monstrosities,  and  the  cases  of  mal- 
formation, which  are  arranged  under  their  especial 
heads,  occupy,  perhaps,  more  space  in  the  Catalogue 
than  some  would  think  they  deserved ; but  the  subject 
is  one  that  well  repays  the  attention  of  the  general 
anatomist ; and  the  description  of  many  of  the  speci- 
mens, however  illustrated,  must  necessarily  be  much 


INTRODUCTION. 


Vll 


detailed.  Reference  was  constantly  made,  in  the  dis- 
section of  these  specimens,  to  the  work  of  M.  Isidore 
Geoffroy  St.  Hilaire,  which  may  he  supposed  to  contain 
about  all  that  is  known  upon  the  subject,  and  an  at- 
tempt was  made  to  follow  his  classification,  but  this  was 
found  to  be  impossible.  His  nomenclature  might  have 
been  used  in  many  cases,  but  as  it  could  not  always  be 
strictly  followed,  it  was  thought  best,  in  referring  to  the 
work,  to  mention  the  volume  and  page,  and  not  trouble 
the  reader  with  a name  that  would  seldom  convey  any 
meaning,  or  not  fail  to  be  soon  forgotten ; one  of  his 
terms,  however,  as  a solitary  exception  to  the  above  re- 
mark, has  been  used  in  the  index  at  the  end  of  the 
volume. 

About  four  years  since,  the  library  of  Dr.  George 
B.  Doane,  one  of  our  earliest  and  most  respected  mem- 
bers, was,  after  his  very  sudden  death,  presented,  by 
one  of  his  family,  to  the  Society,  with  his  collection  of 
instruments;  the  whole  being  contained  in  a handsome 
case,  expressly  provided  for  the  purpose,  and  corres- 
ponding to  those  in  which  the  anatomical  specimens  are 
displayed.  This  was  an  important  acquisition,  and  one 
that  had  been  long  desired  ; the  foundation  of  a library 
was  at  once  laid,  to  which  have  since  been  added  many 
valuable  pathological  and  other  works,  and  which  has 
already  proved  highly  useful  to  the  members  of  the 
Society. 

In  regard  to  the  general  prospects  of  the  Society, 
they  were  never  better  than  at  the  present  time.  The 


vm 


INTRODUCTION. 


meetings  are  well  attended  and  well  sustained,  and  tend 
to  the  promotion  of  good  feeling  as  well  as  of  medical 
science.  The  Cabinet,  the  Library,  and  the  Records  of 
nearly  twenty  years,  faithfully  kept,  now  form  a sub- 
stantial basis.  The  same  spirit  that  founded  the  So- 
ciety, and  has  thus  far  actuated  its  members,  still  pre- 
vails, and,  it  is  hoped,  will  perpetuate  its  existence,  and 
render  it  for  many  years  to  come  deserving  of  the  sig- 
nificant name  it  bears. 


CONTENTS. 


No.  of 
Specimens. 

I.  Healthy  Bones. 

Page. 

1-11. 

Development,  ..... 

1 

12-19. 

Adult  bones,  ...... 

1 

20-22. 

Effects  of  old  age,  .... 

2 

23-27. 

Structure,  ...... 

2 

28-38. 

Anatomical  varieties,  .... 

3 

39-76. 

National  skulls,  ..... 

4 

77. 

II.  Diseased  Bones. 
Skeleton,  ..... 

10 

78-111. 

Head,  ...... 

(l 

112-158. 

Trunk,  

19 

159-196. 

Upper  extremity,  ..... 

. 37 

197-303. 

Lower  extremity,  .... 

45 

304-318. 

III.  Soft  Parts  about  the  Bones. 
Ligaments,  &c.  ..... 

. 68 

319-320. 

IV.  Heart  and  Blood  Vessels. 
Pericardium,  ..... 

73 

321-359. 

Heart,  ....... 

tc 

360-376. 

Arteries,  ...... 

89 

377  - 380. 

Veins,  ....... 

. 100 

i 

X 


CONTENTS. 


No.  of 
Specimens. 

V.  Organs  of  Sense. 

Page. 

381-392. 

Nervous  system, 

102 

393-396. 

Eye, 

105 

397-403. 

Ear,  ........ 

108 

404-405. 

Nose,  ........ 

110 

406-421. 

Skin,  ....... 

111 

422-437. 

VI.  Vocal  and  Respiratory  Organs. 

Air  passages,  ...... 

114 

438  - 445. 

Lungs,  ....... 

120 

446-447. 

Bronchial  glands,  ...... 

125 

448-449. 

Pleura, 

126 

450-455. 

VII.  Alimentary  Canal. 

Healthy  Anatomy,  ..... 

126 

456-466. 

Malformation,  ...... 

128 

467-472, 

Pharynx  and  (Esophagus,  .... 

131 

473_484. 

Stomach,  ....... 

133 

485-507. 

Small  Intestine,  . ... 

138 

508-521. 

Large  Intestine,  ...... 

151 

522-533. 

Foreign  Substances,  ..... 

157 

VIII. 

Organs  Accessory  to  the  Alimentary  Canal. 

534-540. 

Teeth,  ........ 

160 

541-544. 

Mesentery  and  Peritoneum, 

161 

545-572. 

Liver,  ........ 

162 

573-576. 

Pancreas,  ....... 

172 

577-584. 

Spleen, 

176 

IX.  Urinary  Organs. 


585-594. 

Kidneys,  ...... 

ISO 

595-596. 

Renal  Capsules,  .... 

. 184 

597-601. 

Pelvis  and  Ureter,  .... 

185 

602-608. 

Bladder,  ..... 

. 186 

609-648. 

Foreign  Substances,  Calculi,  &c. 

189 

CONTENTS. 


XI 


X.  Female  Organs  of  Generation. 


No.  of 
Specimens. 

Page. 

649-668. 

Uterus, 

. 202 

669-675. 

Vagina  and  External  Organs, 

212 

676-684. 

Ovaries,  ...... 

. 214 

685. 

Breast, 

XI.  Male  Organs  of  Generation. 

216 

686-695. 

Testicle, 

. 217 

696-700. 

Prostate  Gland,  .... 

219 

701-708. 

Penis,  ....... 

XII.  Utero-gestation. 

. 220 

709-724. 

Parts  belonging  to  the  Mother, 

221 

725-756. 

Product  of  Conception,  .... 
XIII.  Monstrosities. 

. 231 

757  - 833. 

Monstrosities  by  Deficiency, 

239 

834-874. 

Monstrosities  by  Excess, 

. 297 

875-879. 

Monstrosities  by  Distortion, 

XIV.  Parasites. 

316 

880-912. 

XV.  Miscellaneous  Specimens. 

. 317 

913-936. 

Appendix. 

323 

937  - 954. 


328 


CATALOGUE  OF  THE  CABINET. 


I.  HEALTHY  BONES. 


i.  Development. 

1 - 5.  A series  of  foetal  skeletons,  from  the  third  to  the  ninth 
month ; in  No.  4,  there  are  thirteen  ribs  upon  each  side. 

6.  An  entire  set  of  separated  foetal  bones ; mounted,  and  displayed 

in  a glass  case.  From  Paris.  Dr.  George  C.  Shattuck , Jr. 

7.  Separated  bones  of  the  head  of  a seven  months  foetus. 

8.  Longitudinal  and  transverse  sections  of  the  long  bones  of  a 

mature  foetus,  to  show  the  central  canal. 

9.  A collection  of  the  bones  of  a child,  consisting  of  an  intermaxil- 

lary, several  vertebrae  in  connexion,  a scapula,  humerus,  radius, 
ulna,  ischium  and  pubes,  femur  and  tibia ; the  peculiarity  in 
the  seventh  cervical  vertebra  is  well  shown. 

10.  The  humerus,  radius  and  ulna  of  a young  adult. 

11.  Cranium  of  a child  about  eight  years  of  age. 

n.  Adult  Bones. 


12.  A skeleton,  from  Paris. 

1 


Dr.  W.  Charming. 


2 


HEALTHY  BONES. 


13.  A cranium. 

14.  A very  beautiful  French  preparation.  The  bones  of  the 

cranium  are  disarticulated,  and  mounted,  so  as  to  be  seen 
separately  and  in  relation.  The  bloodvessels  and  nerves  are 
also  represented,  and  the  alveoli  are  cut  away  to  show  the 
teeth.  Dr.  George  C.  Shattuck,  Jr. 

15.  A skull,  from  which  the  bones  of  the  face  have  been  removed. 

16.  Vault  of  the  cranium. 

17.  A skull  prepared  in  Paris  ; shows  a longitudinal  section,  and  a 
dissection  of  the  internal  ear.  Dr.  Charles  T.  Jackson. 

18.  A skull  prepared,  by  a section  through  the  bones  of  the  face, 
to  show  the  sinuses  and  their  relations. 

19.  Sections,  mostly  longitudinal,  of  the  dorsal,  lumbar  and  sacral 
vertebras,  sternum,  humerus,  radius,  ulna,  upper  and  lower 
extremities  of  the  femur,  tibia,  fibula,  os  innominatum  and  os 
calcis. 


hi.  Effects  of  Old  Age. 

20.  Edentulous  lower  jaw,  with  others  more  or  less  so. 

21.  Edentulous  upper  jaw,  the  alveolar  portion  being  at  one  part 
extremely  thin. 

22.  Base  of  the  skull,  showing  finely  the  change  of  the  hone  in 
case  of  senile  atrophy,  and  contrasting  well,  in  the  lightness 
of  its  structure,  with  the  last  specimen ; the  alveoli  here  also 
are  completely  absorbed. 


xv.  Structure. 

23.  Calcined  bone. 


24.  Humerus  and  ulna  of  an  adult,  from  which  the  earthy  matter 


HEALTHY  BONES. 


3 


was  removed  by  an  acid,  and  having  been  then  steeped  in  a 
saturated  solution  of  salt,  they  retain,  on  being  dried,  a certain 
degree  of  flexibility ; the  radius  is  also  preserved  in  its  natural 
condition.  Prepared  for  the  society  by  Mr.  James  Blake. 

25.  Portion  of  the  humerus  of  an  Albatross,  from  which  the  earthy 
matter  has  been  removed  ; dried  and  varnished. 

26.  Portions  of  a bone  and  tooth  of  the  American  Mastodon,  from 
which  the  earthy  matter  has  been  removed  by  an  acid,  and 
showing  that  nearly  if  not  all  of  the  animal  matter  remains  ; a 
wet  specimen.  For  a full  chemical  analysis  of  the  bones, 
teeth  and  tusks  of  the  Mastodon  giganteum , see  Dr.  C.  T. 
Jackson’s  article  in  the  Boston  Journal  of  Natural  History, 
(Yol.  V.  No.  iii.  1847.) 

27.  Portion  of  the  femur  of  an  Ox,  to  show  the  lamellated  structure 
of  bone. 

v.  Anatomical  Varieties. 

28.  Skull  of  an  adult,  showing  a persistence  of  the  frontal  suture. 

29.  Ossa  Wormiana. 

30.  A portion  of  the  skull  removed,  to  show  a Wormian  bone, 
equal  to  about  two  inches  in  diameter,  of  a somewhat  triangular 
form,  and  situated  at  the  junction  of  the  occipital  and  frontal 
bones.  From  a young  lady,  aged  sixteen,  who  died  of  exten- 
sive apoplexy,  with  softening  of  the  brain. 

31.  Part  of  the  skull  of  an  old  person,  showing  an  enlargement  of 
the  frontal  sinuses. 

32.  Opening  of  considerable  size  between  the  spinous  processes  of 
the  lumbar  and  sacral  vertebrae. 

33.  Sacrum  open  posteriorly,  almost  throughout. 

34.  Bifurcation  of  a rib  anteriorly. 


4 


HEALTHY  BONES. 


35.  E piste rnal  bones.  The  whole  sternum  is  preserved,  and  upon 
its  upper  edge,  posteriorly,  are  situated  two  symmetrical  bones, 
one  on  each  side  of  the  median  line,  and  about  the  size  of 
large  orange  seeds ; the  mode  of  connexion  with  the  sternum 
was  not  ascertained,  the  bone  having  been  found  in  a heap  of 
others  in  the  dissecting  room.  Since  the  above,  Dr.  H.  has 
met  with  a second  specimen  — April,  1841. 

Dr.  O . W.  Holmes. 

36.  A hole  in  the  middle  of  the  sternum,  between  the  fourth  and 
fifth  ribs,  of  an  oval  form  and  three-fourths  of  an  inch  in 
length. 

37.  A perforation  in  the  sternum,  situated  as  in  the  last  specimen, 
but  not  larger  than  a goose  quill. 

38.  A scapula,  showing  a foramen  instead  of  the  supra-scapular 
notch. 


vi.  National  Skulls. 

The  internal  capacity  of  each  specimen  will  be  given  in  cubic 
inches,  and  to  estimate  this,  the  cavity  of  the  cranium  was 
filled  with  shot,  ten  to  an  inch,  and  these,  having  been  well 
rammed  down,  were  poured  off  and  measured  in  a metre 
which  was  very  accurately  graduated  for  the  purpose  by 

Dr.  N.  B.  Shurtleff. 

39.  Skull  from  a church  in  the  Island  of  Scio ; several  extensive 
sabre  wounds  are  seen,  the  individual  having  undoubtedly  been 
massacred  at  the  time  of  the  insurrection  in  1822.  Int.  cap. 
76  in.  This  and  the  two  next  specimens  were  brought  home 
by  Capt.  William  D.  Phelps , and  presented  to  the  Society  by 

Dr.  N.  B.  Shurtleff. 

40.  Skull  of  a Maltese.  The  cranial  portion  is  elongated,  depressed, 
and  remarkable  for  its  uniformity  and  want  of  character.  Int. 
cap.  83  inches. 

41.  A second  skull  from  the  Island  of  Malta,  but  taken  from  a 


HEALTHY  BONES. 


5 


place  where  the  French  soldiers  only  were  buried.  The 
cranium  is  capacious,  broad  and  elevated,  the  length  being 
diminished  in  proportion  ; posteriorly  the  development  is  very 
marked ; sutures  much  obliterated.  The  face  is  not  propor- 
tionally large,  and  the  alveoli  are  particularly  shallow.  Int. 
cap.  85  inches. 

42.  An  Egyptian  cranium ; well  formed ; face  rather  flat ; int.  cap. 
95  cub.  in.  The  greater  part  of  the  skeleton  is  also  preserved, 
the  bones  of  the  pelvis  having  been  cemented  together.  This 
is  one  of  several  specimens  which  were  sent  to  this  country 
by  the  late  John  Lowell , Esq.,  and  was  presented  to  the  Society 
by  his  brother,  Mr.  F.  C.  Lowell;  when  received  it  was 
wrapped  in  bandages,  and  enclosed  in  a sarcophagus. 

43—4.  Two  Theban  skulls,  the  capacity  of  the  first  being  95  cubic  ' 
inches,  and  of  the  second  844-  In  the  first,  the  parietal  protu- 
berances are  very  prominent,  as  in  the  Sandwich  Island  crania, 
with  some  other  resemblances ; there  is  also  persistence  of  the 
frontal  suture.  Rev.  Theodore  Parker. 

45.  Skull  from  the  river  Ganges ; int.  cap.  804  in. ; incisor  teeth 
filed.  Dr.  D.  H.  Storer. 

46-8.  Three  skulls,  from  the  river  Ganges,  presented  by  Dr. 
Francis  G.  Minot;  int.  cap.  of  the  first  and  second  95 
in.,  and  of  the  third  764  in.  In  the  first  two  there  is  a very 
marked,  shelving  projection  of  the  alveoli,  and  a very  remark- 
able want  of  symmetry  in  the  form  of  the  whole  posterior 
portion  of  the  cranium,  the  right  side  being  prominent  in  the 
first  specimen,  and  the  left  depressed,  whilst  in  the  second  the 
reverse  is  the  case.  In  the  third  the  occiput  is  very  protube- 
rant, as  it  is  also  in  the  first,  but  the  other  characters  above 
noticed  are  wanting. 

49.  A Chinese  skull,  with  the  cervical  vertebrae  attached;  some  of 
the  flesh  remains,  dried  on,  and  with  it  the  long,  plaited  hair. 
The  individual  to  whom  this  skull  belonged,  having  been 
engaged  with  two  others  in  smuggling  opium,  they  were  all 
three  decapitated,  and  their  heads  were  placed  conspicuously 


6 


HEALTHY  BONES. 


in  separate  cages  near  the  bank  of  the  river  between  Macao 
and  Canton.  There  they  remained  until  at  last  a descent  was 
made  upon  them  in  the  night,  and  they  were  carried  off ; one 
was  sent  to  London,  and  the  present  specimen,  having  been 
brought  home  by  Capt.  George  Kilham , of  this  city,  was  given 
to  Dr.  Paul  Simpson , and  by  him  presented  to  the  Society. 

50-1.  Two  Chinese  skulls,  brought  from  Macao,  and  presented  by 
Dr.  M.  S.  Perry.  The  int.  cap.  of  the  first  is  69^  inches, 
and  of  the  second  634  inches,  the  second  being  that  of  a child 
about  five  years  of  age ; in  the  first  there  is  the  longitudinal 
ridge  from  the  frontal  bone  to  the  vertex,  as  observed  in  the 
Mongols. 

52.  Skull  of  a Celebes  Islander ; teeth  filed  and  blackened ; int. 
cap.  92  in.  Dr.  C.  H.  Stedman. 

53-8.  Skulls  from  the  Sandwich  Islands.  Int.  cap.  of  No.  53,  86 
in. ; of  No.  55,  88^  in. ; of  No.  56,  85J-  in. ; of  No.  57,  90£ 
in.,  and  of  No.  58,  83  in.  Several  of  these  specimens  are 
characterized  by  the  width  and  symmetry  of  form  of  the  upper 
portion  posteriorly,  and  by  the  prominence  of  the  parietal  pro- 
tuberances, though  one  of  them  (No.  57)  forms  a remarkable 
exception.  The  palatine  fossa  is  generally  short.  In  one 
(No.  56)  the  temporal  and  frontal  bones  meet  upon  the  right 
side,  though  not  upon  the  left,  and  in  this  specimen  and  one 
other  there  are  seen  Wormian  bones,  which  are  said  to  be 
rarely  observed  in  the  savage  races.  No.  53  was  presented  by 
Dr.  D.  H.  Storer ; No.  54,  by  Dr.  C.  H.  Stedman ; Nos.  55, 
56,  57,  by  Dr.  Alexander  Thomas ; and  No.  58  by  Dr.  S.  D. 
Townsend.  This  last  specimen  was  brought  from  the  Island 
of  Oahu  by  Dr.  J.  H.  Lyman , of  Northampton,  and  was  sent 
to  Dr.  T.  with  a full  and  interesting  account  of  the  circum- 
stances under  which  it  was  found.  It  was  far  within  a cave 
near  the  top  of  a volcanic  mountain ; and  with  it  were  found 
great  numbers  of  other  bones.  Some  suppose  that  the  place 
had  been  used  as  a cemeteiy  ; but  others,  that  in  former  times 
the  natives  had  been  besieged  in  the  cave  by  their  enemies 
and  starved  to  death. 


HEALTHY  BONES. 


7 


59.  Skull  of  a negro,  from  the  Western  coast  of  Africa;  presented 
by  Dr.  Stedman.  The  parietal  protuberances  are  marked, 
very  much  as  in  the  Sandwich  Island  skulls.  The  lower  half 
of  the  face  is  also  prominent,  and  the  angle  of  the  lower  jaw 
is  obtuse.  The  temporal  and  frontal  bones  meet  on  the  right 
side,  and  very  nearly  so  on  the  left.  Int.  cap.  95  in. 

60.  Skull  of  a negro;  this  specimen  is  quite  remarkable  for  the 
elongated  and  depressed  form  of  the  cranium,  the  projection 
of  the  alveoli,  the  obtuse  angle  of  the  lower  jaw,  and  the 
nipped  and  slender  appearance  of  the  nasal  bones  ; one  small 
Wormian  bone  is  seen  in  the  temporal  suture,  there  being  two 
in  the  lambdoidal  in  the  last  specimen.  Int.  cap?  78  in. 

Dr.  C.  H.  Stedman. 

61.  An  African  skull,  beautifully  prepared,  and  sent  from  Bahia, 
South  America,  by  Gideon  T.  Snow , Esq.,  formerly  of  this 
city ; presented  to  the  Society  by  the  late  Dr.  J.  C.  Howard. 
This  skull  is  massive  and  heavy,  and  has  all  the  prominences 
and  irregularities  strongly  developed,  with  great  breadth 
between  the  orbits,  a downward  and  forward  projection  of  the 
malar  bones,  and  a protrusion  of  the  alveoli,  the  characteristics 
of  brute  force  being  strongly  marked.  Int.  cap.  89  in.  The 
broad  and  rounded  form  of  the  nasal  opening,  which  belongs 
to  the  negro  race,  is  marked  in  this  skull,  but  still  more  so  in 
No.  107.  The  following  is  an  extract  from  a letter  which 
accompanied  this  specimen  : The  individual  “ was  a genuine 
African,  of  the  Nago  tribe,  esteemed  above  all  other  blacks 
for  their  tall  stature,  breadth  of  shoulders,  symmetiy  and 
strength  of  limb,  united  to  an  intelligence  not  usually  found 
among  the  blacks  of  other  tribes.  This  was  the  tribe  which 
revolted  here  last  January  (1835,)  and  this  was  one  of  the 
chiefs  in  the  affair.  He  was  killed  after  a most  desperate 
contest,  the  courage  of  this  tribe  being  fully  equal  to  their 
Herculean  strength.” 

62.  Cranium  of  a Gay-head  Indian  (Martha’s  Vineyard.)  The 
subject  stated  that  he  was  full-blooded,  fifty-six  years  of  age, 
and  had  had  no  education ; died  of  consumption.  The  jaws 
are  quite  prominent,  as  in  the  negro,  the  two  races  being  much 


8 


HEALTHY  BONES. 


intermixed  in  this  tribe ; palate  deep  and  narrow ; angle  of 
lower  jaw  well  marked ; sutures  much  obliterated,  and  upon 
the  top  of  the  head  some  appearance  of  a ridge,  as  in  the 
Mongols ; int.  cap.  87  in.  Dr.  C.  H.  Stedman. 

63.  Indian  skull,  from  Martha’s  Vineyard,  and  much  better  charac- 

terized than  the  last  specimen.  A most  remarkable  Wor- 
mian bone  is  seen  in  place  of  the  upper  portion  of  the  occiput, 
and  equal  to  at  least  two  and  a half  inches  in  extent.  Int.  cap. 
81  in.;  being  rather  frail,  this  skull  was  measured  with  white 
pepper.  Dr.  C.  T.  Jackson. 

64.  Skull  of'a  Monhegan  Indian,  from  Tappan’s  Island,  Damaris- 

cotta  River,  Maine ; formerly  a celebrated  burial-place,  but 
not  used  for  the  last  two  hundred  years.  Well  characterized ; 
int.  cap.  75  in.  Dr.  C.  T.  Jackson. 

65.  Skull  of  a Penobscot  Indian;  occiput  quite  prominent  and 
sutures  much  obliterated.  Int.  cap.  79  in. 

Dr.  C.  H.  Stedman. 

66.  Skull  of  one  of  the  Uncas  tribe  of  Indians,  Connecticut. 

Dr.  C.  H.  Stedman. 

67.  Portions  of  skulls  dug  up  in  the  North  part  of  this  city,  and 

supposed  to  be  of  Indian  origin.  Dr.  H.  G.  Clark. 

68-9.  Two  Skulls,  from  the  Columbia  river;  in  their  general 
aspect  they  resemble  the  figure  of  the  Kalapooyah  in  Dr. 
Morton’s  Crania  Americana,  (pi.  47.)  Int.  cap.  of  the  first, 
80  in.,  and  of  the  second,  89^-  in.  These  two  specimens  were 
procured  by  Mr.  Phinehas  S.  Davis , of  this  city.  Mr.  D. 
states  that,  in  the  year  1842,  he  spent  four  months  at  the  river, 
and  obtained  these  two  skulls  and  one  other  at  Coffin  Island  ; 
this  island  is  upon  the  river,  about  eighty  miles  from  its  mouth, 
and,  though  nothing  more  than  a small  rock,  is  a favorite 
burying  place  with  the  natives.  There  were  about  fifteen 
coffins  upon  the  island,  but  the  three  skulls  which  he  brought 
away  were  all  that  he  saw.  These  coffins,  so  called,  are  their 
common  canoes,  in  which  the  body  is  covered  up,  and  placed. 


HEALTHY  BONES. 


9 


sometimes  upon  the  ground,  sometimes  on  the  side  of  a hill, 
with  one  end  resting  upon  a tree,  and  sometimes  supported 
upon  poles,  their  bracelets  and  other  ornaments  being  buried 
with  them.  With  regard  to  the  flattening  of  the  head,  Mr.  D. 
says  that  it  is  commenced  when  the  infant  is  a few  months  old, 
and  is  continued  for  a year,  more  or  less,  the  child  being  bound 
to  a board,  with  a piece  of  bark,  or  something  of  the  kind,  to 
press  upon  the  forehead.  He  never  saw  but  one  child  under 
the  process,  and  that  one  did  not  appear  to  suffer  from  it ; he 
had,  however,  seen  many  young  children  after  the  completion 
of  the  process,  and  the  deformity  was  generally  greater  in 
them  than  in  the  adults ; he  also  observed  that  the  form  of  the 
head  before  the  process  was  begun,  was  not  at  all  remarkable. 

70.  Cast,  in  plaster,  of  a Carib  head.  Dr.  William  E.  Coale. 

71-2.  Two  well  formed  skulls,  brought  from  the  coast  of  California, 
by  Capt.  William  D.  Plielps , of  this  city,  and  presented  by 
Dr.  N.  B.  Shurtleff.  No.  71  is  thick  and  heavy,  with  long 
styloid  processes,  and  very  large  nasal  bones.  In  both,  the 
palatine  fossa  is  short,  deep  and  narrow.  Int.  cap.  of  No.  71, 
75A  in.,  and  of  No.  72,  77^  in.  No.  72,  seems  to  have  been 
shot  through  the  back  of  the  head  and  left  orbit. 

73.  Peruvian  skull,  of  the  Inca  race  ; flattened  posteriorly,  but 

symmetrical.  Dr.  C.  T.  Jackson. 

74.  A second  specimen ; in  this  skull  there  is  not  merely  the  flat- 
tening posteriorly,  but  the  want  of  symmetry  which  is  so 
characteristic  of  this  race,  and  to  a most  remarkable  degree, 
the  prominence  being  on  the  right  side ; several  Wormian 
bones  are  seen  about  the  lambdoidal  suture.  Int.  cap.  764  in. 

Dr.  S.  D.  Townsend. 

75.  A third  specimen,  brought  from  the  “ Temple  of  the  Sun.” 
Some  of  the  soft  parts  remain,  dried  on,  and  a large  quantity 
of  soft  auburn  hair,  being  partially  detached,  has  been  removed 
and  placed  in  a jar  by  the  side  of  the  skull.  The  subject  was 
a child  four  or  five  years  old.  Int.  cap.  59J-  in.  In  this  speci- 
men there  are  three  upper  incisor  teeth  upon  the  right  side ; 

2 


10 


DISEASED  BONES. 


the  additional  one  was  between  the  two  others,  and  in  the 
same  range,  but  smaller  in  size,  so  far  as  can  be  judged  by 
the  sockets,  for  the  teeth  themselves  have  fallen  out. 

Dr.  H.  A.  Ward. 

76.  Skull  of  an  ancient  Peruvian,  characterized  as  usual  by  the 
elongated  form,  the  flattening  of  the  frontal  portion,  and  the 
rounded  development  of  the  posterior  and  upper  portions.  Int. 
cap.  70J  in.  Dr.  Winslow  Lewis. 


II.  DISEASED  BONES. 


i.  Skeleton. 

77.  Skeleton  of  a little  girl,  eight  years  of  age,  who  was  affected 
with  rickets,  and  was  also  said  to  have  been  idiotic.  Cranium 
sufficiently  well  formed.  The  whole  spine  is  curved  some- 
what backwards,  but  not  laterally,  and  the  acetabula  are 
pushed  in,  so  as  to  encroach  upon  the  cavity  of  the  pelvis.  All 
of  the  long  bones  are  more  or  less  curved,  some  greatly  so, 
and  none  more  than  the  femurs,  of  which  the  left  has  been 
broken  and  well  united.  The  whole  skeleton  is  very  light,  and 
in  the  recent  state  appeared  to  possess  a cartilaginous  elasticity. 

Dr.  George  ParJcman. 


ii.  Head. 

78.  The  top  of  the  cranium,  showing  the  effects  of  a severe  burn 
which  occurred  in  infancy  ; the  patient  was  forty-two  years  of 
age,  and  died  from  a tuberculous  disease  of  the  spinal  marrow 
(Yid.  specimen.)  The  right  parietal  bone,  to  a considerable 
extent,  is  rough  on  the  surface,  and  more  or  less  thin,  with  a 
perforation  about  two-thirds  of  an  inch  in  diameter.  The 
patient  was  bald  on  that  side  of  his  head,  the  scalp  in  a cica- 
trized state,  and  directly  over  the  diseased  bone  was  an  exten- 
sive scab,  which,  according  to  his  report,  had  always  been 
there,  and  was  very  tender. 


DISEASED  BONES. 


11 


79.  Cranium  of  a Mink,  showing  a caries  of  the  anterior  portion  of 
the  lower  jaw. 

80.  Cranium  of  a Skunk,  showing  the  same  as  the  above. 

Dr.  Winslow  Lewis. 

81.  A small  glass  jar,  containing  several  bones  of  a Skunk.  The 

lower  jaw,  which  on  one  side  is  enlarged  anteriorly  and  carious ; 
two  of  the  caudal  vertebrae,  and  the  lower  extremity  of  one  of 
the  tibiae  have  a considerable  quantity  of  new  bone  thrown  out 
on  the  surface,  and  two  of  the  metatarsal  bones  are  firmly 
anchylosed.  A carious  femur  from  another  subject  is  also 
shown.  Dr.  Jeffries  Wyman. 

82.  Necrosis  of  the  greater  part  of  the  body  of  the  lower  jaw, 

including  that  portion  of  the  alveolar  processes  which  contains 
the  incisor  teeth.  Several  openings  exist  on  the  surface, 
through  which  the  old  bone  is  seen  within,  a part  of  it  being 
already  loose.  This  was  the  result  of  a blow ; the  patient  was 
a sailor,  and  died,  ten  months  after  the  accident,  from  acute 
pneumonia.  Dr.  C.  H.  Stedman. 

83.  Recovery  from  gangrenopsis,  after  the  exfoliation  of  a large 
portion  of  the  upper  maxillary  bone,  and  a portion  of  the 
lower  maxillary  in  front,  the  crowns  of  one  molar  and  two 
incisor  teeth  of  the  second  set  having  also  been  thrown  off ; 
the  bones  and  teeth  are  shown.  From  a little  girl,  four  years 
of  age.  May  3d,  1832,  she  was  attacked  with  severe  cerebral 
symptoms.  On  the  9th,  a swelling  appeared  on  the  outside  of 
the  left  cheek,  red,  tense  and  shining,  and  very  soon  after- 
wards a gangrenous  spot  was  seen  on  the  centre  of  the  inside 
of  the  cheek,  with  a separation  of  the  gum  from  the  upper 
jaw  ; her  aspect  was  very  bad,  and  the  vomiting  and  cerebral 
symptoms  continued,  with  alternate  restlessness  and  coma  ; the 
skin  was  cool.  She  had  taken  mercury,  but  the  mouth  had 
not  been  affected.  This  state  continued  for  two  or  three  days, 
when  the  gangrene  began  to  extend  along  the  upper  and  lower 
jaw.  On  the  18th,  the  cheek  was  hard,  falling  in  on  the  out- 
side, the  skin  only  having  escaped  the  destructive  process ; 
slough  separating  from  the  inside ; had  some  appetite.  On 


12 


DISEASED  BONES. 


the  24th,  there  was  extensive  sloughing  of  the  gums,  and  the 
upper  maxillary  bone  was  denuded;  otherwise  doing  well. 
June  18th,  bone  separating ; by  the  end  of  this  month  the 
exfoliation  was  completed,  and  the  general  health  quite  re- 
established. Dr.  John  Ware. 

84.  Top  of  the  cranium,  much  thickened.  Dr.  C.  H.  Stednian. 

85.  A portion  of  frontal  bone,  much  thickened;  from  a man  who 
had  been  regarded  as  idiotic.  (See  specimen,  No.  119.)  The 
cranium,  generally,  was  more  or  less  thickened.  1837. 

86.  Disease  of  the  bones  of  the  cranium  and  face  of  a South 
American  Monkey;  probably  scrofulous.  The  structure  is 
very  light  and  earthy,  and  the  top  of  the  cranium  having  been 
sawed  off,  shows  a great  degree  of  thickening.  1833. 

Dr.  J.  B.  S.  Jackson. 

87.  An  adult  cranium,  showing  an  extreme  thinness  of  the  bone  in 
the  occipital  fossa,  being,  to  some  extent,  not  thicker  than 
writing  paper ; the  bone  has  become  cracked,  the  edges  are 
curled  up,  and  there  is  some  appearance  of  an  entire  deficiency. 

' Something  of  the  kind  is  also  seen  in  the  squamous  portion  of 
each  of  the  temporal  bones,  the  cranium  being  otherwise  well. 
1841.  Dr.  William  E.  Coale. 

88.  Bones  of  the  vault  of  the  cranium  held  together  by  membrane ; 

they  are  exceedingly  thin,  especially  towards  the  margin, 
radiate  from  the  centre,  and  resemble  the  foetal  bones  in 
structure.  From  a negress,  aged  forty-five,  who  was  said  not 
to  have  been  hydrocephalic,  though  it  is  impossible  to  conceive 
of  any  other  disease  that  could  have  produced  such  a change 
in  the  bones.  Dr.  George  Parkman. 

89.  A plaster  cast  of  the  skull  of  an  old  negro,  showing  a deep, 
extensive  and  symmetrical  depression  upon  each  side  between 
the  parietal  protuberances  and  the  vertex ; there  is  also  a 
remarkable  flattening  in  the  temporal  regions.  The  structure 
of  the  bone  was  very  light  and  spongy,  and  in  some  places  it 
was  extremely  thin.  This  deformity  has  been  seen  by  Dr.  W. 
in  three  other  specimens.  1847.  Dr.  Jeffries  Wyman. 


DISEASED  BONES. 


13 


90.  Ivory  exostosis.  Fragments  of  a large  bony  tumor,  which  was 

removed  from  the  forehead  by  Dr.  Richard  Barnum,  of  North 
Carolina ; the  case  was  published,  with  an  engraving,  in  the 
Baltimore  Medical  and  Surgical  Journal,  (vol.  i.  p.  242.)  The 
patient,  a middle-aged  man,  had  had  the  symptoms  of  nasal 
polypus  for  a year  or  more,  when  about  the  first  of  April,  1830, 
the  tumor  began  to  appear,  having  been  preceded  for  some 
days  by  violent  head-ache  and  considerable  fever.  About  the 
first  of  May  it  became  very  painful,  and  was  then  nearly  as 
large  as  at  the  time  of  the  operation.  Soon  after  this  he  had 
convulsions,  followed  by  coma,  which  continued  for  several 
days.  On  the  first  of  June  a large  portion  of  the  tumor  was 
removed,  measuring  three  inches  in  diameter  at  the  base,  and 
one  and  a half  inches  in  height,  with  complete  relief  to  the 
stupor  and  convulsions,  but  the  effect  was  attributed  to  the  loss 
of  blood  and  counter-irritation.  In  the  summer  of  1831  the 
left  eye  became  amaurotic,  and  in  September,  1832,  a mass  of 
disease  appeared  on  the  forehead,  as  shown  in  the  engraving, 
the  progress  of  the  case  from  this  time  not  being  given. 
The  density  and  structure  of  the  fragments  are  highly  charac- 
teristic of  this  kind  of  tumor ; under  the  microscope,  however, 
it  has  the  usual  appearance  of  bone,  as  shown  by  Dr.  Wyman, 
a section  having  been  prepared  by  him  to  accompany  the 
specimens.  1843.  Dr.  William  E.  Coale. 

91.  Exostosis  from  the  horn  of  a Deer;  it  is  as  large  as  the  fist, 
heart-shaped,  and  of  an  ivory  hardness.  This  specimen  was 
picked  up  in  the  woods  in  the  South  of  Illinois. 

Boston  Society  of  Natural  History. 

92.  A tumor,  or  exostosis,  as  it  would  be  called  in  the  mammalia, 
found  upon  one  of  the  bones  about  the  lower  jaw  of  a Cod-fish. 
It  is  about  the  size  of  a small  orange,  of  a rounded  form, 
uneven  upon  the  surface,  dense  in  structure,  and  composed 
apparently  of  fibres  radiating  from  the  centre.  Having  been 
sawed  open,  the  bone  is  seen  to  pass  directly  through  its  centre, 
becoming  enlarged,  loose  in  its  structure,  and  intimately  con- 
nected with  the  substance  of  the  tumor.  Dr.  Winslow  Leiuis. 

93.  Portion  of  parietal  bone ; inner  surface,  to  the  extent  of  about 


14 


DISEASED  BONES. 


two  inches,  has  a fretted,  coral-like  appearance,  and  is  slightly 
thickened.  From  a child,  four  years  of  age,  that  died  of 
general  scrofulous  disease.  1834.  Dr.  J.  B.  S.  Jackson. 

94.  Portion  of  parietal  bone,  showing  a superficial  absorption  of  the 

external  surface  to  the  extent  of  about  one-third  of  an  inch ; 
it  is  well  defined,  and  nearly  circular ; surface  rough,  and 
when  recent,  somewhat  vascular ; all  of  the  surrounding  parts, 
bone  and  membrane,  were  quite  healthy.  From  a young  man 
who  died  with  cerebral  symptoms.  This  appearance  might 
readily  be  mistaken  for  a closure  of  the  opening  left  by  a 
trephine.  1837.  Dr.  J.  B.  S.  Jackson. 

95.  “ The  skull  of  a man  who  died  from  the  effects  of  a combina- 
tion of  syphilis  and  mercury.  Pus  made  its  way,  through  the 

K base  of  the  skull,  and  thus  occasioned  his  death.”  The  deep- 
seated  bones  on  the  right  side  of  the  face  are  extensively 
destroyed.  1845.  Dr.  Charles  H.  Stedman. 

96.  Portion  of  the  frontal  bone  from  an  old  syphilitic  case.  It  is 

nearly  half  an  inch  thick  and  quite  solid,  the  diploe  being 
effaced;  rough  on  the  outside,  corresponding  to  superficial 
ulcerations  which  existed  there,  and  still  more  so  upon  the 
inside  where  the  dura  mater  adhered.  The  pericranium  was 
much  thickened,  and  the  left  anterior  lobe  of  the  brain  greatly 
diseased.  From  a man  about  forty  years  of  age.  He  had 
had  syphilis  about  fifteen  years  before  death,  and  for  the  last 
ten  had  been  subject  to  intense  headache,  chiefly  on  the  left 
side  ; died  from  an  extension  of  disease  to  the  substance  of  the 
brain,  the  symptoms  of  which  were  neither  severe  nor  of  long 
duration.  1834.  Dr.  A.  A.  Gould. 

97.  Disease  of  the  whole  top  of  the  cranium,  from  a patient,  aged 

sixty,  who  died  of  cancer  of  the  breast;  a very  beautiful 
specimen.  A considerable  part  of  the  bone  has  been  entirely 
destroyed,  much  of  it  is  left  as  a delicate,  reticulated  structure, 
and  the  whole  is  more  or  less  rough  from  the  process  of 
absorption.  Many  of  the  other  bones  were  diseased  in  the 
same  way.  Dr.  S.  D.  Townsend. 


DISEASED  BONES. 


15 


98.  Disease  of  the  lower  jaw,  from  the  same  patient  as  the  last 
specimen ; the  left  side  only  is  preserved.  The  ramus  has 
become  a mere  shell,  and  is  broken  through ; body  enlarged, 
and  rough  on  the  outside,  the  soft  parts,  when  recent,  being 
thickened  and  condensed,  somewhat  as  in  the  next  specimen. 

Dr.  S.  D.  Toivnsend. 

99.  Excision  of  nearly  one  half  of  the  lower  maxillary  bone  for 

malignant  disease,  by  Dr.  Walker ; removed  at  the  articula- 
tion. The  specimen  is  preserved  in  spirit,  and  shows  a dense, 
fibro-cellular  degeneration  of  the  soft  parts  about  the  bone. 
The  patient  was  the  wife  of  a physician,  who  gave  the  follow- 
ing history  of  the  case : The  operation  was  performed  in 
June,  1829,  the  tumor  being  then  about  the  size  of  a hen’s 
egg,  uneven  on  the  surface,  and  veiy  hard;  skin  distended, 
and  of  a deep  red,  approaching  to  chocolate  color;  side  of 
face  much  swollen  ; pain  almost  constant,  and  at  times  excru- 
ciating; general  health  much  impaired.  The  pain  began  in 
the  summer  of  1823,  and  about  two  or  three  years  afterwards, 
a small,  hard  tumor  was  first  perceived  about  the  lower  jaw  on 
the  left  side ; the  disease  had  been  progressive,  and  was 
rapidly  so  from  the  time  of  her  marriage  in  June,  1828,  till 
her  confinement  in  the  following  March.  After  the  operation 
she  was  tolerably  comfortable  for  a time,  but  the  disease 
returned,  and  in  the  course  of  a year  the  swelling  of  the  face 
and  tumor  were  as  large  as  ever,  the  surface  frequently  bleed- 
ing. Symptoms  gradually  increased,  and  she  died  in  June, 
1831 ; eleven  weeks  previously  she  fractured  the  thigh  in  an 
attempt  to  turn  herself  in  bed,  the  bone  uniting  in  less  than 
six  weeks.  Dr.  William  J.  Walker , of  Charlestown. 

100.  Lower  maxillary  bone  of  a Heifer ; an  indurated,  diseased 

mass  had  been  removed  during  life,  and  as  it  appeared  to  be 
of  a malignant  nature,  the  animal  was  afterwards  killed.  The 
bone  is  affected  to  the  whole  extent  of  the  alveoli ; it  is  much 
enlarged,  and  partially  hollowed  out,  several  smooth,  rounded 
openings  communicating  with  the  interior ; on  the  outside  is  a 
deep  cavity  nearly  as  large  as  the  palm  of  the  hand  ; the 
structure  of  the  bone  generally  is  sound,  and  there  is  no  new 
deposit.  1841.  Dr.  J.  W.  McKean. 


16 


DISEASED  BONES. 


101.  Malignant  disease  of  the  antrum  ; a wet  specimen.  The  mass 

is  four  or  five  inches  in  diameter,  partly  covered  by  integu- 
ment, and  being  cut  through,  after  it  had  been  some  time  in 
spirit,  appears  to  consist  of  a firm,  white,  curdy  substance. 
Removed  after  death  from  a man  aged  twenty-two.  The 
disease  was  on  the  right  side,  and  had  existed  about  two  years ; 
the  eye  was  pushed  out,  and  the  sight  of  both  ultimately 
destroyed  ; nose  pushed  to  one  side,  and  the  roof  of  the  mouth 
broken  down ; ulceration  through  cheek  upon  the  centre  of 
the  tumor,  and  copious  haemorrhage  from  this  part ; died 
comatose.  Dr.  S.  D.  Townsend. 

102.  Large  portion  of  the  parietal  bone  gone,  the  result  of  an  old 

fracture,  the  opening  being  closed  by  the  dura  mater  and  the 
pericranium,  which  were  very  dense  and  as  firm  as  parchment. 
The  patient,  a coachman,  died  from  a second  fracture  of  the 
same  bone.  Dr.  George  Parkman. 

103.  Old  fracture  of  the  left  parietal  bone,  leaving  an  opening  two 
inches  in  length  by  three-fourths  of  an  inch  in  width,  and  closed 
by  the  thickened  and  adhering  pericranium  and  dura  mater. 
The  mark  of  a trephine  is  distinctly  seen,  about  two-thirds  of 
a circle,  the  surrounding  bone  being  thickened,  and  rough  on 
the  outside,  but  on  the  inside  smooth.  The  patient,  aged  thirty- 
five,  fell  through  the  decks  of  a man  of  war  in  1827,  and 
fractured  the  bone.  In  1829  he  began  to  have  fits  resembling 
those  of  epilepsy,  with  other  cerebral  symptoms ; afterwards 
struck  the  part  in  a fall  down  stairs,  and  became  much  worse. 
In  December,  1830,  he  entered  the  Massachusetts  General 
Hospital ; pressure  on  the  affected  part  caused  pain  ; constant 
headache  ; numbness  with  loss  of  power  in  right  arm  and  leg ; 
in  January  he  was  trephined.  For  eighteen  months  after  the 
operation  he  was  much  better,  but  the  disease  gradually  re- 
turned, and  he  died  in  April,  1833.  On  removing  the  bone, 
the  membranes  were  found  thickened,  and  adherent  to  the 
brain  ; a portion  of  this  last  was  softened  and  completely  disor- 
ganized to  the  depth  of  one  and  a half  inches,  and  to  some 
extent  around  this  spot  the  membranes  and  cineritious  substance 
were  closely  united,  and  of  a cartilaginous  hardness.  A full 
history  of  the  case  up  to  the  period  of  the  patient’s  leaving  the 


DISEASED  BONES. 


17 


Hospital  was  published  in  the  Medical  Magazine,  (vol.  i.  p.  93.) 

Dr.  Charles  G.  Putnam. 

104.  An  old  fracture  of  the  cranium,  about  the  junction  of  the 

frontal  and  parietal  bones,  leaving  an  opening  about  one  and 
a fourth  by  two-thirds  of  an  inch.  Anteriorly  the  bone  is 
nearly  half  an  inch  in  thickness,  and  from  its  inner  surface 
there  projects  a solid  mass  of  bone  of  considerable  size,  form- 
ing a part  of  the  circumference  of  the  opening ; there  is 
nothing  externally  to  indicate  the  situation  of  this  exostosis,  if 
the  trephine  had  been  applied  during  life,  for  the  relief  of  the 
epilepsy  to  which  the  patient  had  been  subject.  “From  a man 
aged  twenty-four.  When  eight  years  old  he  was  kicked  by  a 
horse  on  the  top  of  the  head,  and  was  for  a long  while  disabled, 
many  pieces  of  bone  coming  away.  From  that  time  he  had 
frequent  attacks  of  epilepsy,  usually  after  indulgence  in  food ; 
constant  sense  of  uneasiness  in  head  ; no  pulsation  felt  at 
injured  part.  Two  weeks  before  death  he  had  a very  severe 
paroxysm,  was  bled  to  three  pints,  and  soon  resumed  his  busi- 
ness. On  the  night  before  his  death  he  had  a slight  attack, 
several  in  the  course  of  the  following  day,  and  at  eight  o’clock, 
P.  M.,  died.”  1834.  Dr.  J.  W.  M'Kean. 

105.  Fracture  through  the  base  of  the  skull.  1845. 

Dr.  Charles  H.  Stedman. 

106.  An  extensive  fracture  through  the  base  of  the  skull,  extending 
on  the  left  side  into  the  parietal  bone.  1845. 

Dr.  Charles  H.  Stedman. 

107.  Skull  from  Porto  Rico ; near  the  left  temple  are  seen  the 

remains  of  an  old  and  extensive  injury,  probably  a sabre  wound. 
The  subject  was  a negro.  1838.  Dr.  D.  H.  Storer. 

108.  Extensive  sabre  wound  of  the  right  frontal  bone  ; there  is  still 

a small  opening  quite  through,  though  the  injury  seems  to  have 
been  well  repaired.  Received  on  board  of  one  of  the  United 
States  vessels  during  the  war  of  1812.  1840. 

Dr.  S.  D.  Townsend. 


3 


18 


DISEASED  BONES. 


109.  A cranium,  showing  a ball  lodged  in  the  frontal  bone,  just 
above  the  right  orbit  and  towards  the  median  line,  and  which 
had  been  in  that  situation  for  about  twenty-five  years.  The 
patient,  aged  forty-five,  was  sail-maker  on  board  the  sloop  of 
war  Enterprise  in  her  engagement  with  the  Boxer.  Whilst 
loading  a cannon,  a shot,  probably  from  a canister,  hit  the 
carriage  of  the  gun,  and  glancing,  struck  him  in  the  forehead 
and  threw  him  senseless  on  the  deck.  In  a few  moments  he 
arose  and  finished  loading  his  gun,  and  whilst  doing  so,  as  he 
said,  the  ball  dropped  out  upon  the  deck ; he  afterwards 
received,  in  the  same  engagement,  a severe  sabre  cut,  which 
penetrated  the  cavity  of  the  abdomen.  In  December,  1839, 
he  entered  the  United  States  Marine  Hospital,  at  Chelsea,  with 
pneumonia.  When  convalescent,  he,  of  his  own  accord,  intro- 
duced some  lint,  and  plugged  up  the  wound  in  the  forehead, 
which  had  always  remained  open,  discharging  pus  freely  ; two 
days  afterwards  he  was  taken  sick,  and  tire  lint  was  removed 
with  much  relief;  he,  however,  continued  to  grow  worse,  and 
died  the  next  day  of  very  extensive,  acute  meningitis.  One 
half  of  a large  leaden  ball  is  seen  to  be  firmly  imbedded  in  the 
bone  in  the  situation  above  described,  the  flat  section  being 
external  and  oblique,  with  an  opening  quite  through  into  the 
cavity  of  the  cranium,  and  around  this,  upon  the  inside,  some 
deposit  of  new  bone.  A question  arises  as  to  whether  the  ball 
was  discharged  in  the  form  in  which  it  is  now  seen,  or  whether 
it  was  split  as  it  glanced  against  the  gun-carriage.  1840. 

Dr.  Charles  H.  Stedman. 

110.  A large  portion  of  the  lower  jaw  shot  away,  the  patient 
recovering  with  a very  good  mouth.  The  specimen  consists 
of  a single,  entire  piece,  including  the  whole  width  of  the 
jaw,  and  to  the  full  extent  of  the  incisor  teeth,  and  one,  if  not 
two,  of  the  bicuspids.  The  wound  was  received  on  board  of 
the  Guerriere,  in  her  action  with  the  Constitution ; the  bone 
was  not  entirely  detached  till  about  a fortnight  after  the 
injury,  and  the  soft  parts  having  been  brought  together,  the 
result  was  as  above  stated.  1842.  Dr.  S.  D.  Toumsend. 

111.  Cranium  of  a Duck,  showing  an  old,  united  fracture  of  the 


DISEASED  BONES. 


19 


long,  slender  bone  which  articulates  posteriorly  with  the  os 
quadratum.  Dr.  Jeffries  Wyman. 

in.  Trunk. 

1 12.  Superficial  caries  of  the  bodies  of  three  or  four  dorsal  vertebrae ; 
no  curvature.  From  a man  who  died  at  the  House  of  Industry 
with  symptoms  of  spinal  disease.  Dr.  J.  W.  M'Kean. 

113.  Caries  of  the  bodies  of  the  four  last  cervical  vertebrae;  wings 

of  the  third  and  fourth  anchylosed.  From  a little  girl,  aged 
eleven,  who  died  from  extensive  tuberculous  disease  in  the 
lungs  and  intestines.  Several  cervical  glands  were  enlarged 
early  in  the  disease,  and  about  five  months  before  death  she 
complained  of  pain  in  her  neck,  sometimes  radiating  off  to  the 
shoulders  ; neck  stiff.  Dr.  Woodbridge  Strong. 

114.  Bodies,  wings,  and  in  part,  the  articulating  processes  of  the 
third  and  fourth  cervical  vertebrae  firmly  anchylosed ; the 
result  of  former  caries.  From  a man  who  died  of  phthisis  ; 
nothing  known  of  any  affection  of  the  neck.  1838. 

Dr.  Charles  H.  Stedman. 

115.  One  lumbar  and  five  dorsal  vertebrae;  bodies  extensively 

carious,  two  of  them  being  almost  entirely  destroyed ; 
processes  for  the  most  part  healthy.  Several  of  the  ribs 

also  preserved,  being  more  or  less  carious,  and  some  of 
them  extensively  so ; some  deposit  of  new  bone  on  surface. 
From  a man  who  died  with  all  the  symptoms  of  phthisis,  but, 
upon  examination,  an  abscess  was  found  near  the  spine  com- 
municating with  the  lungs.  Dr.  S.  D.  Townsend. 

116.  Caries  of  the  spine.  The  bodies  of  the  two  last  dorsal  verte- 

brae and  first  lumbar  are  nearly  destroyed ; an  abscess  existed 
on  each  side  of  the  spine,  and  on  one  side  extended  nearly  to 
the  groin.  From  a boy,  six  or  seven  years  old  ; always  sickly ; 
curvature  was  one  of  the  first  indications  of  local  disease  ; gait 
awkward  ; never  much  pain  in  back,  but  had  a great  deal  in 
the  groin.  Dr.  Edward  J.  Davenport. 


20 


DISEASED  BONES. 


117.  Backward  curvature  of  the  spine.  The  bodies  of  the  four 
last  dorsal  vertebrae  and  first  lumbar  are  so  far  absorbed  that 
the  eighth  dorsal  and  second  lumbar  approach  within  a line  of 
each  other ; firm  anchylosis  has  taken  place ; spinous  and 
transverse  processes  more  or  less  absorbed,  the  depression  of 
the  first,  which  generally  exists  in  these  cases,  being  here 
strongly  marked.  Connected  with  the  disease  was  an  abscess, 
which,  terminating  in  a fistula,  followed  the  iliac  vessels,  and 
opened  on  the  outside  of  the  left  thigh ; in  this  last  were  some 
of  the  contents  of  the  intestines,  and  it  undoubtedly  communi- 
cated with  the  colon  with  which  it  was  in  contact,  though  the 
opening  was  not  found.  The  disease,  being  advanced  thus  far 
towards  recoveiy,  had  reappeared  in  another  place  ; the  bodies 
of  the  fourth  and  fifth  dorsal  vertebrae  are  about  one  half  de- 
stroyed, the  fifth  being  detached  from  its  wings ; slight  curvature 
had  commenced,  and  an  abscess,  evidently  more  recent  than 
the  one  below,  extended  from  the  diseased  vertebrae  upwards 
and  along  the  left  side  of  the  spine  as  far  as  the  neck,  but  did 
not  open  externally.  The  intervertebral  substance  between 
the  second  and  third  and  the  third  and  fourth  dorsal  vertebrae 
was  completely  broken  down  into  a soft,  shreddy  substance 
infiltrated  with  pus,  yet  the  body  of  the  third  is  not  much 
diseased  and  the  second  not  at  all  so.  The  intervertebral  sub- 
stance, also,  from  the  fifth  to  the  ninth,  is  entirely  destroyed, 
so  far  as  appears  externally,  the  bones  being  in  contact,  though 
for  the  most  part,  they  do  not  seem  to  be  anchylosed ; these 
vertebrae,  again,  are  but  slightly  carious ; the  disease,  then,  in 
this  case,  seems  to  have  begun  in  the  intervertebral  substance. 
The  pelvis,  which  is  preserved  in  connection  with  the  spine,  is 
perfectly  well  formed,  and  this  is  an  interesting  fact  in  an 
obstetric  view.  The  spinal  marrow  has  also  been  preserved,  and 
will  be  found  under  its  appropriate  head.  The  lungs  were  free 
from  tubercles,  and  the  other  organs  were  sufficiently  healthy. 

From  a young  man,  aged  nineteen  years.  Health  always 
delicate.  Disease  began  about  six  years  before  death,  and 
was  attributed  to  a fall  from  a horse.  Suffered  much  from 
sense  of  stricture  across  epigastrium,  and  also  from  pain  in 
back  when  he  walked ; no  paralysis.  Almost  from  the  first  of 
the  disease  there  had  been  an  opening  in  the  left  thigh,  some- 
times in  one  place,  sometimes  in  another,  and  if  at  any  time 


DISEASED  BONES. 


21 


these  openings  were  closed,  his  sufferings  were  very  much 
increased ; for  the  last  four  or  five  months  liquid  fseces  and 
flatus  were  occasionally  discharged  through  the  fistula.  The 
patient  kept  his  bed  during  a great  part  of  his  sickness,  and 
became  excessively  emaciated  and  deformed.  The  above 
history  was  obtained  after  the  patient’s  death,  from  an  intelligent 
brother-in-law.  1835.  Dr.  J.  B.  S.  Jackson. 

1 18.  Backward  curvature  of  the  spine.  The  patient,  a brick-layer, 
was  about  thirty  years  of  age,  and  had  been  under  the  care  of 
Dr.  George  B.  Doane.  Eight  or  nine  years  before  his  death 
he  fell  about  sixteen  feet  from  a ladder,  and  struck  his  back ; 
walked  home  with  the  help  of  a friend,  and  was  out  on  the 
following  day.  The  accident  happened  in  May ; through  the 
summer  he  kept  about,  but  always  complained  of  pain  in  his 
back.  In  the  autumn,  after  a few  days  work,  which  was  all 
he  did  from  the  time  of  the  accident,  the  pain  became  quite 
severe,  and,  on  examination,  his  wife  discovered  a backward 
projection  of  the  spine.  Sensation  and  power  of  motion  were 
afterwards  completely  lost  in  the  feet  and  legs,  and  so  con- 
tinued for  about  three  years,  during  which  time  issues  were 
kept  open  on  the  back;  the  sphincters  were  not  affected. 
After  three  or  four  years  he  got  well  enough  to  keep  a small 
shop,  the  pain  being  always  very  great  in  the  back,  and  some- 
times in  the  side.  Died  at  last  of  disease  of  the  hip-joint.  (See 
specimen  204.)  The  bones  of  the  fifth,  sixth,  seventh  and 
eighth  dorsal  vertebrae  are  so  far  absorbed  that  the  spine  is 
bent  to  a right  angle  ; they  are  very  irregular  and  imperfectly 
anchylosed.  Articulating  and  spinous  processes  firmly  anchy- 
losed,  as  are  also  three  ribs  upon  each  side.  Bodies  of  two 
vertebrae  immediately  below  the  curvature  considerably  ab- 
sorbed on  the  right  side.  The  sacrum  was  also  carious.  (No. 
124.)  Spinal  canal  sufficiently  free.  1837. 

119.  Very  extensive  backward  curvature  of  the  spine.  The  patient, 
who  had  been  under  the  care  of  Dr.  John  Ware,  was  an  un- 
married female,  twenty-six  years  of  age,  feeble  from  birth. 
The  curvature  commenced  when  she  was  twelve  years  of  age  ; 
dated  from  a moxa  applied  to  the  back  for  chronic  ophthalmia  ; 
increased  for  three  or  four  years,  after  which  it  remained 


22 


DISEASED  BONES. 


stationai'y  ; when  it  commenced  there  was  for  a time  some 
loss  of  power  in  the  lower  extremities.  On  examination  after 
death,  the  curvature  was  strongly  marked  externally,  but  not 
angular;  chest  very  prominent  anteriorly,  the  sternum  rounded, 
and  the  deformity  altogether  very  great.  Face  livid.  Great 
cedema  of  lower  extremities,  and  in  the  peritoneal  cavity  seve- 
ral pints  of  serum.  Old  adhesions  of  both  pleurae,  but  the 
lungs  quite  free  from  tubercles.  The  aorta,  also,  was  healthy 
and  of  natural  size,  though  like  the  spine,  it  was  sharply 
bent  upon  itself.  At  the  curvature  and  just  on  the  right 
of  the  spine  was  an  old  cyst,  which  was  filled  with  a quantity 
of  white  pasty  substance,  the  bone  not  being  exposed.  The 
diseased  portion  of  the  spine  having  been  prepared,  the  curva- 
ture is  seen  to  be  very  strongly  marked,  and  such  as  to  form 
an  angle  of  twenty-five  or  thirty  degrees.  The  bodies  of  the 
eight  last  dorsal  and  first  lumbar  vertebrae  are  extensively 
carious  anteriorly,  and  the  last  three  dorsal  are  nearly  de- 
stroyed ; the  third  and  fourth  dorsal  are  also  carious,  but  the 
second  lumbar  is  healthy  ; the  condition  of  the  other  vertebrae 
was  not  observed  at  the  time  of  the  dissection.  The  last  eight 
dorsal  are  firmly  united  by  the  bodies  and  wings,  but  the  rest 
are  free.  One  of  the  ribs  on  the  right  side  is  anchylosed,  and 
all  of  them  about  the  curvature  were  more  or  less  diseased 
and  compressed  ; transverse  processes  sufficiently  well,  except 
those  of  the  last  two  or  three  dorsal  vertebrae ; spinous 
processes,  as  usual,  much  depressed.  1840. 

120.  Four  first  lumbar  vertebrae  perfectly  consolidated  into  one 
mass,  and  so  reduced  in  size  as  to  occupy  the  space  anteriorly 
of  but  three-fourths  of  an  inch ; the  result  of  former  caries. 
The  backward  curvature  was  very  slight,  but  still  it  could  be 
perceived  upon  the  external  surface  of  the  body.  Having 
been  sawed  through  longitudinally,  the  bodies  of  these  four 
vertebras  are  seen  to  consist  of  one  large,  continuous  mass  of 
perfectly  healthy  bone,  without  any  vestige  of  intervertebral 
substance.  The  last  dorsal  and  lumbar,  and  the  sacral  verte- 
brae are  seen  to  be  healthy.  From  a stout,  healthy-looking 
man,  fifty  years  of  age,  who  died  at  the  Hospital,  April  21st, 
1837,  from  pericarditis  supervening  on  rheumatism.  The 
records  state  that,  when  eleven  months  old,  he  received  an 


DISEASED  BONES. 


23 


injury  of  the  back,  and  did  not  use  his  feet  for  three  years 
afterwards,  and  that  he  had  been  regarded  as  idiotic  from  the 
time  of  the  accident.  (See  specimen  85.) 

121.  The  bodies  of  the  last  dorsal  and  two  upper  lumbar  vertebrae 
perfectly  consolidated,  and  reduced  in  size  so  as  to  measure 
but  one  and  a fourth  inches  along  their  anterior  face  ; back- 
ward curvature  slight,  though  sufficiently  marked  at  time  of 
dissection ; the  result,  undoubtedly,  of  caries,  though  there  is 
no  trace  of  existing  disease.  From  a married  woman,  about 
twenty-five  years  of  age,  who  died  under  the  care  of  Dr. 
Homans,  of  phthisis,  with  extensive  tuberculous  disease  of  the 
kidneys.  When  about  six  years  of  age  she  had  pain  in  back, 
so  as  to  require  medical  aid ; this  continued  for  about  two 
years,  after  which  she  had  occasionally  some  obscure  trouble 
there,  but  this  may  hdve  been  owing  to  the  disease  of  the 
kidneys,  which  from  the  symptoms  and  morbid  appearances, 
must  have  been  much  anterior  to  the  disease  in  the  lungs. 
The  mother,  who  gave  the  history  of  the  case,  never  observed 
any  backward  curvature  of  the  spine  till  about  four  years 
before  death.  1838. 

122.  Old  disease  of  the  spine.  The  body  of  one  of  the  dorsal 

vertebras  has  been  so  far  absorbed  that  the  anterior  edges  of 
the  adjoining  vertebrae  meet,  and  here  become  firmly  anchy- 
losed.  In  addition  to  this,  which  is  the  result  of  former  caries, 
the  bodies  of  several  of  the  neighboring  vertebrae  are  anchylosed 
by  bony  matter  thrown  out  upon  their  edges.  From  a laboring 
man,  aged  fifty-six,  who  died  at  the  Massachusetts  General 
Hospital,  of  urinary  abscess.  His  sister  reported  that  he  had 
been  hump-backed  since  he  was  thirteen  years  of  age,  but  that 
he  was  never  paralyzed,  nor  otherwise  confined  by  his  spinal 
disease.  July.,  1842.  Dr.  George  Hayward , Jr. 

123.  Lateral  curvature  of  the  spine  of  a Pickerel.  The  body  of 
the  seventh  vertebra  from  the  head  is  completely  absorbed  on 
the  right  side,  but  not  at  all  on  the  left,  giving  it,  therefore,  a 
wedge-shaped  form,  and  producing  a curvature  having  an  angle 
of  about  forty-five  degrees.  One  rib  on  each  side  was  anchy- 
losed, but  they  have  been  accidentally  broken  off.  The  whole 


24 


DISEASED  BONES. 


spine  and  most  of  the  cranium  have  been  preserved,  and  are 
otherwise  healthy.  The  subject  of  this  specimen  was  taken 
with  the  hand  in  a brook,  and,  when  first  seen  in  the  water, 
the  deformity  was  very  striking ; there  was  no  appearance 
externally  of  former  injury.  1838.  Dr.  Jeffries  Wyman. 

124.  Extensive  caries  of  the  upper,  anterior  part  of  the  sacrum. 

It  is  strongly  anchylosed  to  the  last  lumbar  vertebra  and  a mass 
of  new  bone  is  thrown  out  over  the  junction  of  the  bodies  of 
the  two  bones  ; the  upper  edge  of  the  lumbar  vertebra  is  also 
fringed  with  new  bone  ; the  whole  is  light  and  spongy.  From 
a man,  aged  thirty,  who  died  from  disease  of  the  spine,  &c. 
(See  No.  118.)  1837. 

125.  Caries  with  necrosis  of  the  sacrum  where  it  unites  with  the 
left  ilium,  there  being  an  irregular  cavity,  and  in  it  three 
loose  pieces  of  dead  bone ; the  corresponding  portion  of  the 
ilium  was  also  diseased,  but  has  not  been  preserved.  From  a 
female,  about  thirty  years  of  age  ; had  had  pain  for  a year 
and  a half,  and  a fistulous  opening  at  the  left  groin  for  some 
months  ; continued  to  work  as  a domestic  till  three  weeks 
before  death,  when  she  entered  the  House  of  Industry,  after 
which  she  was  attacked  with  diarrhoea  and  sank  rapidly.  The 
fistula  extended  to  the  diseased  articulation.  1836. 

Dr.  ill.  S.  Perry. 

126.  An  atlas,  divided  upon  the  median  line  into  two  equal  portions  ; 

from  an  adult,  dissecting-room  subject.  Anteriorly,  the  division 
extends  through  the  centre  of  the  articulating  surface  for  the 
odontoid  process,  the  opposing  surfaces  being  broad,  like  the 
symphysis  pubis,  and  the  edges  everted  and  rough,  except 
towards  the  articulation,  which  last  is  perfectly  smooth  and 
healthy.  Posteriorly,  the  wings  very  nearly  meet  hi  two 
smooth,  blunt  points.  1847.  Dr.  N.  B.  Shurtleff. 

127.  The  fifth  lumbar  vertebra,  supposed  by  Dr.  S.  to  have 
belonged  to  the  same  subject  as  the  last  specimen.  The 
wings  are  separated  on  each  side  from  the  body  of  the  bone 
between  the  two  articulating  processes,  but,  as  in  case  of  the 
atlas,  without  any  appearance  of  disease  or  injury. 


DISEASED  BONES. 


25 


128.  Absorption  of  the  anterior  portion  of  the  bodies  of  three  of 
the  dorsal  vertebrae.  The  surface  is  irregular,  but  was  covered, 
when  recent,  by  a thin,  semi-organized  membrane,  and  formed 
part  of  the  parietes  of  an  aneurismal  cavity  ; the  intervertebral 
substance  was  then  prominent,  as  usual  in  these  cases.  The 
aneurism  was  situated  at  the  upper  part  of  the  abdominal  aorta, 
and  caused  death  by  bursting  through  into  the  right  lung.  The 
patient,  a middle-aged  man,  died  at  the  Hospital,  June  17th, 

1836.  Dr.  Jeffries  Wyman. 

129.  One  dorsal  and  five  cervical  vertebra,  showing  some  degree 
of  exostosis  about  the  edges  of  the  bodies. 

130.  Exostosis  from  the  edges  of  the  bodies  of  the  four  last  cervi- 
cal vertebra,  the  two  last  being  anchylosed. 

Dr.  George  C.  Shattuck , Jr. 

131.  Bodies  of  five  dorsal  vertebra  strongly  anchylosed  by  a growth 
of  bone  from  their  edges,  this  being,  as  often  observed,  mostly 
upon  the  side.  The  union  is  only  partial,  but  where  it  does 
not  exist,  there  is  a fringed  exostosis,  showing  different  stages 
of  the  same  affection.  Dr.  E.  W.  Carpenter , of  Chatham. 

132.  Bodies  of  two  dorsal  vertebra  firmly  anchylosed  by  a thick, 
solid  mass  of  new  bone  arising  from  the  edges  ; sawed  longi- 
tudinally, and  one  half  only  is  preserved.  1838. 

Dr.  Winslow  Lewis. 

133.  Lumbar  vertebra  of  a Horse  ; edges  of  the  bodies  united  by 

thick,  strong  masses  of  bone  passing  across  like  clasps  from 
one  to  the  other.  Dr.  J.  D.  Fisher. 

134.  Strong  anterior  curvature  of  the  inferior  extremity  of  the 
sacrum. 

135.  Dislocation  of  the  cervical  vertebra,  without  fracture ; opera- 
tion by  Dr.  W.  J.  Walker.  The  accident  happened  in  July, 

1837.  The  patient,  a stout  teamster,  fell  from  his  wagon, 
which  was  heavily  loaded,  in  such  a way  that  both  of  the 
wheels  passed  over  his  neck.  Severe  symptoms  immediately 

4 


26 


DISEASED  BONES. 


ensued,  and  continued,  when  he  was  seen  by  Dr.  W.,  about 
forty-eight  hours  after  the  accident.  There  was  then  complete 
loss  of  sensation  and  power  of  motion  below  the  injured  part ; 
respiration  entirely  by  the  diaphragm  ; urine  passed  only  by 
the  catheter,  and  without  any  expulsive  effort ; some  priapism  ; 
no  dejection  without  medicine,  though  a small  dose  only  was 
required  ; consciousness  perfect.  On  the  following  day,  an 
incision  having  been  made  over  the  seat  of  the  injury,  and  the 
muscles  on  the  right  side  dissected  back,  there  was  found  to  be 
a complete  dislocation  of  the  fourth  cervical  vertebra  upon  the 
fifth.  The  spinous  process  of  the  fourth  was  so  far  separated 
from  that  of  the  fifth  as  to  allow  a free  examination  of  the 
parts,  and  it  was  also  carried  round  towards  the  left  side  so  that 
the  right  articulating  process  rested  upon  the  posterior  ring  of 
the  fifth,  and  nearly  over  its  spinous  process  ; the  left  articula- 
ting process  of  the  fourth  had  been  tilted  over  that  of  the  fifth, 
and  carried  forward.  No  fracture  of  the  bones  was  discovered, 
and  the  sheath  of  the  spinal  marrow  seemed  uninjured.  The 
head  of  the  patient  being  then  grasped  by  an  assistant  and 
forcibly  extended,  Dr.  W.  pressed  with  his  thumbs  in  opposite 
directions  upon  the  spinous  processes,  by  which  means  the 
reduction  was  perfectly  accomplished,  the  patient  feeling  so 
much  relief  during  the  extension  as  to  desire  that  it  might  be 
continued  ; whilst  it  was  being  made  there  M ere  several  ounces 
of  blood  discharged  from  within  the  cavity.  After  the  opera- 
tion the  symptoms  manifestly  improved ; the  serrati  muscles 
acted  during  inspiration,  and  M'hen  the  right  leg  Mas  scratched 
he  felt  it,  though  he  thought  that  it  M as  the  left ; the  bladder, 
also,  aided  someM'hat  in  expelling  the  urine  by  the  catheter ; 
otherwise  no  change.  About  the  sixth  day  from  the  time  of 
the  accident  he  began  to  grow  M orse,  and  on  the  eighth  he  died. 
On  dissection,  the  vertebrae  Mrere  found  in  place  ; the  interver- 
tebral substance  entirely  broken  through,  but  there  Mas  no 
fracture  of  the  bones  ; spinal  marrow  ecchymosed  to  a small 
extent,  rather  soft,  and  appeared  rather  smaller  than  usual  at 
the  injured  part.  The  preparation  represents  the  vertebras 
dislocated  as  before  the  operation.  In  a case  which  occurred 
in  the  Hospital  in  1836,  the  patient  lived  till  the  thirtieth  day ; 
the  sixth  cervical  Mas  dislocated  upon  the  seventh  ; there  M as 
no  fracture  of  the  bones ; but  a complete  laceration  of  the 


DISEASED  BONES. 


27 


intervertebral  substance,  which  amounts  to  about  the  same  thing. 

136.  Fracture  of  the  cervical  vertebra.  From  a man,  aged  twenty- 

one,  who  fell  fifteen  feet  upon  the  pavement  with  his  head 
bent  upon  the  chest ; the  scalp  was  extensively  lacerated,  but 
the  skull  was  not  fractured.  Died  in  twenty-two  hours  after 
the  accident ; two  hours  before  death  he  expressed  himself  free 
from  pain,  but  could  not  move  a limb ; was  perfectly  rational, 
and  felt  sure  that  his  neck  was  broken.  The  processes  of  the  last 
three  cervical  vertebra  are  more  or  less  broken,  and  the  body 
of  the  seventh  very  much  so,  though  there  seems  to  have  been 
no  displacement.  The  scalp  and  sinuses  of  the  brain  were 
much  crowded  with  blood.  Dr.  Charles  G.  Putnam. 

137.  Fracture  of  the  odontoid  process  of  the  second  cervical  verte- 
bra, from  a man  who  fell  down  stairs  whilst  walking  in  his 
sleep  ; he  lived  a day  or  two  after  the  accident. 

Dr.  Charles  G.  Putnam. 

138.  Fracture  with  displacement  of  the  fifth  dorsal  vertebra ; fatal 
on  the  twenty-fourth  day.  The  patient  was  a healthy-looking 
man,  aged  thirty-five,  and  entered  the  Hospital  on  the  fourth  of 
August,  1840.  Four  days  before,  whilst  on  a pleasure  excursion 
in  the  harbor,  he  attempted  to  dive  into  the  water  from  a 
height  of  thirty  feet,  and  fell  upon  the  gunwale  of  the  vessel, 
striking,  it  was  said,  the  back  of  his  neck,  so  as  to  bend  the 
head  forcibly  forward.  From  the  time  of  the  accident  till 
death  there  was  an  entire  loss  of  the  power  of  motion  and 
sensation  below  the  fifth  rib,  with  paralysis  of  the  sphincters. 
The  urine  was  passed  only  by  the  catheter,  and  after  the 
eleventh  day  was  dark,  thick,  bloody,  very  foetid  and  strongly 
ammoniacal.  There  was  much  dyspnoea,  with  great  pain  in 
the  back  on  motion,  a dry,  coated  tongue,  some  delirium,  tym- 
panites, fever  and  emaciation,  with  sloughing  over  the  back  of 
the  pelvis  ; at  first  some  emphysema  was  observed  on  front  of 
chest,  but  this  very  soon  disappeared.  On  the  fourteenth  day 
the  left  lower  extremities  became  cedematous,  and  in  connection 
with  this  there  was  found  a pretty  extensive  phlebitis.  The 
spine  was  only  examined  once,  and  then  there  was  noted  a 
slight  projection  with  great  tenderness  at  the  seat  of  injury. 


28 


DISEASED  BONES. 


On  dissection,  the  body  of  the  fifth  dorsal  vertebra  was  found 
to  be  broken  through  in  a longitudinally  oblique  direction,  and 
the  fragments  were  so  displaced  that  one  of  them  laid  by  the 
side  of  the  fourth,  and  the  other  against  the  opposite  side  of 
the  sixth  vertebra,  one  of  the  fragments  being  much  commi- 
nuted ; there  was  also  some  displacement  backwards  of  one 
of  them,  and  a fracture  through  the  wings  of  the  fifth  vertebra, 
so  as  to  completely  detach  the  spinous  process.  Three  of  the 
articulating  processes  of  the  fifth,  and  one  of  the  fourth  were 
broken,  with  some  of  the  transverse  processes,  besides  the  right 
clavicle,  and  several  of  the  ribs  on  each  side. 

In  the  specimen,  four  of  the  vertebrae  have  been  prepared, 
with  portions  of  the  ribs,  the  parts  which  had  been  fractured 
or  sawed  out  having  been  attached  by  wires. 

The  theca  was  torn  to  a small  extent,  and  somewhat  ecchy- 
mosed  at  the  seat  of  injury,  and  at  the  same  place  the  spinal 
marrow  had  a pulpy  softness,  and  a faint,  dull,  reddish  brown 
color,  to  the  extent  of  half  an  inch,  with  slight  appearances  of 
the  same  change  for  an  inch  above.  The  muscles  were 
ecchymosed,  and  there  was  a little  blood  in  each  pleural 
cavity,  with  some  inflammation  of  the  membrane.  The 
bladder  was  extensively  gangrenous,  dark,  very  offensive, 
crusted  upon  the  inner  surface  with  an  earthy  deposit,  and 
filled  with  coagulated  blood,  besides  a considerable  amount  of 
the  same  effusion  in  the  parietes  of  the  organ ; anteriorly,  it 
was  comparatively  healthy. 

139.  Very  extensive  fracture  and  displacement  of  the  lumbar  ver- 
tebrae, with  other  injuries;  fatal  on  the  thirty-seventh  day. 
The  patient,  aged  twenty-nine,  was  run  over  by  a fire- 
engine  ; three  hours  afterwards,  when  brought  to  the  Hospital, 
he  had  no  power  to  move  either  of  the  lower  extremities,  and 
no  feeling  in  the  right  leg,  though  there  was  still  some  in  the 
left.  The  ribs  were  extensively  fractured,  and  there  was  dis- 
location of  the  sternal  extremity  of  the  left  clavicle ; specimens 
preserved.  The  accident  happened  on  the  eighth  of  December, 
1838,  and  the  following  symptoms  were  observed : — Entire 
loss  of  the  power  of  motion  of  right  lower  extremity  from  first 
to  last,  but  with  some  power  to  move  the  left  leg  and  toes  ; 
frequent  tingling  and  prickling  in  lower  extremities,  the 


DISEASED  BONES. 


29 


sensibility  being  by  no  means  entirely  lost ; complained  often 
of  great  pain  in  the  lower  extremities  after  the  second  day, 
particularly  about  the  right  knee.  (Edema  of  right  lower 
extremity  after  the  sixth  day,  and  for  the  last  week  there  was 
felt  a firm  cord,  which  was  supposed  to  be  the  femoral  vein. 
Dejections  involuntary  throughout.  Urinary  symptoms  very 
urgent;  the  bladder  has  been  preserved,  and  this  part  of  the 
history  of  the  case  will  be  given  under  its  appropriate  head. 
The  back  was  never  examined  till  the  seventeenth  day,  it  being 
impossible  to  turn  him  on  account  of  the  fractured  ribs ; then 
found  a projection  of  the  spinous  process  of  the  second  lumbar 
vertebra,  and  tenderness  about  this  part,  but  not  elsewhere ; 
also  a slough  over  the  sacrum.  Pulse  generally  varied  from 
90  to  110;  skin  often  hot;  countenance  generally  pale  and 
tranquil ; breathing  at  first  quite  painful,  with  bloody  expecto- 
ration ; slept  sufficiently ; appetite  poor ; tongue  coated  ; abdo- 
men swollen  and  tympanitic ; often  took  cathartics.  Four 
days  before  death  a profuse  haemorrhage  took  place  from  the 
slough,  which  was  then  so  extensive  as  to  have  exposed  the 
sacrum  and  the  sciatic  ligament ; it  was,  however,  stopped  by 
compression,  and  did  not  again  return,  but  from  this  time  the 
patient  sank  rapidly. 

On  examination  after  death,  the  body  was  found  emaciated; 
upper  extremities  rigid,  bu-t  the  lower  flaccid;  no  osdema;  a 
small  slough  on  each  heel,  besides  the  large  one  over  the 
sacrum.  Extensive,  acute  pleurisy  on  right  side,  but  other- 
wise the  organs  of  the  chest  were  healthy.  Stomach  and 
large  intestine  much  distended  with  gas.  Kidneys  and  bladder 
much  diseased,  and  a mass  of  recent  lymph  was  found  in  the 
tunica  vaginalis  of  left  side. 

The  intervertebral  substance  between  the  second  and  third 
lumbar  vertebrae  was  lacerated,  the  anterior-inferior  portion  of 
the  second,  on  the  right  side,  being  broken  off  from  the  body 
of  the  bone  and  remaining  still  connected  with  the  interverte- 
bral substance.  Lateral  displacement  such,  that  the  right  side 
of  the  body  of  the  second  rests  upon  the  left  side  of  that  of 
the  third.  Body  of  the  second  completely  broken  from  its 
processes  on  each  side ; posterior  lamina,  connecting  the  trans- 
verse and  spinous  processes,  broken  through  on  each  side ; the 
inferior  articulating  process,  on  the  left  side,  and  the  superior, 


30 


DISEASED  BONES. 


on  the  right,  are  completely  dislocated,  the  two  others  being 
more  nearly  in  place ; several  small,  detached  pieces  of  bone 
crowded  into  the  cavity  of  the  spinal  canal.  The  transverse 
processes  of  the  first,  second,  third  and  fourth  lumbar  vertebrae, 
on  the  left  side,  and  of  the  second  and  third,  on  the  right,  are 
fractured,  some  of  them  being  partially  united.  Spinous 
processes  of  the  last  dorsal  and  of  the  first  two  lumbar  frac- 
tured; the  first  two  displaced,  but  partially  united.  There 
was  very  little  new  ossific  deposit,  however,  about  the  frac- 
tures. The  spinal  marrow  was  not  examined,  but  some  of  the 
nerves  were  found  elongated  and  much  compressed  by  the 
displaced  fragments. 

140.  Fracture,  with  displacement,  of  the  last  dorsal  vertebra  ; fatal 
at  the  end  of  nine  and  a half  weeks ; from  a patient  of  Dr. 
M.  Gay.  This  patient  was  a laboring  man,  and  engaged  in  the 
removal  of  an  old  building,  when  he  was  suddenly  crushed 
down  by  a fall  of  the  ceiling  of  the  room  in  which  he  was  at 
work.  Immediately  on  being  extricated,  he  found  himself 
paralyzed  below  a line  drawn  horizontally  three  or  four  inches 
below  the  umbilicus,  about  which  line  there  was  severe  pain. 
For  the  first  few  days  the  urine  and  faeces  were  retained,  but 
afterwards  the  discharges  were  involuntary ; towards  the  last, 
however,  the  urine  became  turbid  and  ammoniacal,  and  the 
catheter  was  again  required.  Very  severe  pain,  for  some 
days,  towards  the  sacrum,  but  none  about  the  fracture.  Loss 
of  sensation  and  power  of  motion  complete  in  lower  extremi- 
ties from  the  time  of  the  accident  till  death,  with  frequent 
sense  of  burning  in  legs.  Slight  backward  curvature  over 
seat  of  fracture  for  the  last  three  or  four  weeks,  with  tender- 
ness on  pressure.  Mind  never  affected.  Large  sloughs  formed 
about  the  hips,  with  great  emaciation,  and  the  patient  gradually 
sank. 

The  affected  portion  of  the  spinal  column  having  been  pre- 
pared, and  sawed  open  longitudinally,  there  is  seen  to  have 
been  an  extensive  laceration  of  the  intervertebral  substance 
between  the  eleventh  and  twelfth  dorsal  vertebrae,  with  such 
displacement,  that  the  upper  sharp  edge  of  the  twelfth  must 
have  very  greatly  compressed,  if  not  cut  across,  the  spinal 
marrow.  The  upper  edge  of  the  body  of  the  twelfth  is  broken 


DISEASED  BONES. 


31 


off,  and  remains  in  place,  connected  with  the  intervertebral 
substance  ; the  anterior  portion  of  the  body,  also,  is  partially 
fractured,  or  rather  crushed  down,  as  seen  by  a line  which 
traverses  it  obliquely,  and  the  inferior  articulating  processes  are 
completely  broken  up ; some  deposit  of  new  bone  is  seen  about 
these  last,  but  none  elsewhere.  1836. 

141.  The  entire  spinous  process  of  the  sixth  cervical  vertebra 
broken  off,  and  removed  by  an  operation.  The  patient,  a man 
thirty-nine  years  of  age,  was  struck  upon  the  back  of  the  neck 
by  the  falling  of  a heavy  timber,  on  the  15th  of  June,  1845. 
Immediately  he  lost  all  power  of  motion  and  sensation  below 
the  middle  of  the  chest ; there  was  also  dyspncea,  with  diffi- 
culty of  expectoration,  paralysis  of  the  sphincter  ani,  retention 
of  urine,  and  priapism ; this  last  symptom  lasted  but  for  a short 
time  ; mind  unaffected.  On  the  following  day,  in  consultation 
with  Drs.  J.  C.  Warren,  William  J.  Walker  and  Winslow  Lewis, 
an  operation  was  decided  upon,  and  was  performed  by  Dr. 
John  B.  Walker,  of  this  city;  an  incision  was  made  about  eight 
inches  in  length  over  the  back  of  the  neck,  and,  the  muscles 
having  been  dissected  away,  it  was  found  that  the  spinous 
process  of  the  sixth  cervical  vertebra  was  fractured  and  quite 
loose,  though  not  driven  in ; the  ligaments  which  connect  this 
process  with  the  adjacent  vertebra  were  then  divided,  and  the 
bone  was  seized  and  twisted  out ; before  the  operation  there 
had  been  some  tenderness  over  the  seventh  spinous  process, 
but  no  crepitus  nor  motion  could  be  felt;  the  haemorrhage 
during  the  operation  was  abundant.  The  wound  was  closed 
by  four  sutures,  and  healed  without  any  trouble.  On  the  18th, 
the  third  day  from  the  operation,  there  was  some  return  of 
sensibility,  and  on  the  first  of  September  it  was  reported  as 
quite  natural.  Catheter  required  for  the  first  few  days,  but,  on 
the  19th,  the  discharge  of  urine  was  involuntary,  and  so  con- 
tinued for  some  months,  since  which  time  he  has  had  sufficient 
control  of  the  bladder;  was  also  able  to  give  notice  before  dejec- 
tion. Very  soon  after  the  operation  he  began  to  have  painful, 
muscular  twitchings  of  the  lower  extremities,  or  cramps,  as  he 
called  them,  and  these  he  has  continued  to  complain  of  much 
to  the  present  time ; as  he  lies  upon  his  back,  the  knees  gradu- 
ally tend  to  draw  up,  and  when  they  have  been  extended,  to 


32 


DISEASED  BONES. 


do  which  requires  considerable  force,  he  is  for  a time  quite 
easy ; there  is  also  rigidity,  with  a sense  of  burning,  and  an 
increase  of  the  cramps  from  an  exposure  to  heat  or  cold,  or 
from  an  attempt  to  move  the  limbs.  About  the  first  of  Sep- 
tember, it  was  observed,  as  he  laid  with  his  knees  drawn  up 
and  spread  out,  that  he  had  some  power  to  bring  them  together, 
but  the  attempt  was  apt  to  bring  on  the  cramps ; there  was 
afterwards  some  increase  of  power,  but  not  much,  and  for  a 
long  time  past  his  condition  has  been  about  stationary.  Mean- 
while, there  has  been  but  little  if  any  emaciation,  and  his 
general  health  has  been  sufficiently  good.  Never  any  pain  in 
neck,  and  the  upper  extremities  have  never  been  affected. 
Specimen  presented,  and  the  above  history  of  the  case  given, 
April  12th,  1847,  by  Dr.  John  B.  Walker. 

142.  Old  fracture  of  the  last  dorsal  vertebra.  The  patient,  a 
healthy  young  man,  twenty-four  years  of  age,  fell  about  thirty 
feet,  from  the  spire  of  a church,  in  June,  1842,  and  lived  till 
the  month  of  May,  1846.  From  the  time  of  the  accident 
until  his  death,  there  was  an  entire  loss  of  the  power  of  motion 
and  sensibility  in  the  lower  extremities,  with  more  or  less 
paralysis  of  the  sphincters.  In  October,  1843,  he  entered  the 
Massachusetts  General  Hospital,  and  remained  there  four 
months ; on  admission,  there  was  observed  a considerable  pro- 
jection of  the  two  last  dorsal  vertebrae,  a slough  on  the  sacrum, 
and  ulcers  on  the  legs,  these  last  having  been  caused  without 
the  patient’s  consciousness  by  the  application  of  hot  water; 
paralysis  entire,  with  occasionally  much  pain  in  lower  extremi- 
ties. Whilst  he  was  in  the  Hospital  the  discharge  of  urine 
was  involuntary ; on  the  1 1th  of  January,  it  was  reported  as 
“ quite  turbid  and  semi-purulent,”  and  so  it  continued  till  his 
death,  but  without  much  pain.  In  connection  with  these  last 
symptoms  there  were  found  calculi  in  the  urinary  bladder,  with 
much  disease  of  that  organ  and  of  the  kidneys ; the  bladder 
and  the  calculi  have  been  preserved,  and  are  described  in 
another  place. 

A portion  of  the  spinal  column,  consisting  of  four  vertebrae, 
having  been  prepared,  it  appears  as  if  the  body  of  the  last 
dorsal  had  been  crushed  or  broken  down  by  the  fall,  but  not 
much,  if  at  all,  displaced  ; and  that  subsequently  the  injured 


DISEASED  BONES. 


33 


cancellated  structure  had  been  absorbed,  and  a curvature  in- 
duced, giving  to  the  bone  a wedge-like  form,  so  that  whilst  it 
has  about  its  usual  thickness  posteriorly,  it  is  so  thin  anteriorly 
that  the  bodies  of  the  adjoining  vertebra  would  very  nearly 
meet,  if  it  were  not  for  a bony  ring  or  lip  which  arises  from 
the  thin  edge  and  projects  over  the  upper  edge  of  the  vertebra 
below.  Upon  each  side,  and  to  some  extent,  the  inferior  por- 
tion of  the  body  of  the  bone  posteriorly  seems  to  be  uninjured. 
The  spinous  process  preserves  its  usual  relations  to  the  one 
below,  but,  as  the  curvature  has  gone  on,  the  lamina  have 
become  elongated,  so  that  now  there  is  not  merely  a wide 
separation  between  this  spinous  process  and  the  eleventh,  but  a 
deficiency  of  bone  between  the  base  of  the  two  processes  to 
the  extent  of  nearly  an  inch,  and  in  this  respect  this  specimen 
differs  very  much  from  one  of  backward  curvature  of  the 
spine.  The  laminae  and  the  base  of  the  transverse  and  upper 
articulating  processes  are  irregular  and  more  or  less  thickened, 
with  some  growth  of  new  bone,  and  it  is  not  at  all  improbable 
that  these  portions  of  the  vertebra  may  have  been  involved  in 
the  fracture.  Upon  the  upper  back  part  of  the  body  the  sur- 
face is  rough  and  carious,  and  here  the  spinal  canal  is  conside- 
rably diminished  in  size,  but,  as  it  would  seem,  rather  from  the 
curvature  and  some  displacement  forwards  of  the  eleventh 
vertebra  than  from  any  projection  backwards  of  the  twelfth. 
The  carious  appearance  extends  to  the  back  of  the  eleventh, 
and  there  is  some  growth  of  new  bone  from  this  vertebra, 
besides  a sharp  prominent  ridge  about  the  carious  part  of  the 
twelfth.  The  patient  had  been  under  the  care  of 

Dr.  C.  H.  Allen , of  Cambridgeport. 

143.  Partial  recovery  after  a severe  injury  of  the  spine,  twenty 
years  before  death.  The  last  three  dorsal  and  first  lumbar 
vertebra  are  preserved.  The  last  dorsal  appears  to  be  the 
only  one  affected  by  the  injury,  except  for  a little  bony  matter 
thrown  out  upon  the  front  of  the  vertebra  above,  with  which  it 
is  pretty  extensively  anchylosed,  though  the  union  seems  to  be 
superficial.  The  body  of  the  vertebra,  posteriorly,  has  its 
natural  thickness,  but  gradually  it  becomes  thinner,  and  ante- 
riorly it  is  reduced  to  one  or  two  lines,  so  far  as  the  anchylosis 
will  allow  of  an  estimate.  There  is  considerable  irregularity 
5 


34 


DISEASED  BONES. 


upon  the  sides  and  about  the  transverse  processes,  and  the 
general  appearance  is  such  as  may  have  been  produced  by  a 
crushing  down  of  the  body  of  the  bone  and  subsequent  absorp- 
tion, though  in  structure  it  seems  now  as  compact  as  the  other 
bones.  The  patient  was  a carpenter,  and  died  in  May,  1842, 
under  the  care  of  Dr.  William  Ingalls,  from  calculus  in 
the  bladder.  Twenty  years  before,  he  fell  from  the  top  of 
a house,  and  the  family  state  that  an  eminent  surgeon,  who 
was  at  once  called  to  him,  considered  his  case  as  one  of  frac- 
ture of  the  spine.  Perfect  paralysis  of  the  lower  extremities 
and  of  the  sphincters  immediately  ensued,  and  he  kept  his  bed 
for  two  years,  being  removed  only  upon  a sheet,  and  requiring 
a constant  use  of  the  catheter.  From  the  time  of  the  acci- 
dent, he  never  recovered  the  use  of  his  limbs,  though  for  the 
last  ten  years  he  moved  about  rather  more,  dragging  the  limbs 
after  him,  his  general  aspect  being  feeble,  and  his  sufferings 
from  the  urinary  disease  being  much  of  the  time  very  urgent. 

144.  Obscure  injury  of  the  neck.  The  cervical  vertebrae,  having 
been  prepared  in  connection,  there  is  seen  to  be  a wide  separa- 
tion between  the  spinous  processes  of  the  first  and  second,  a 
retreating  of  the  body  of  the  second,  when  viewed  laterally, 
with  a very  marked  depression  of  this  vertebra  upon  the  left 
side,  as  shown  not  merely  in  the  altered  form  and  size  of  the 
body  of  the  bone,  but  in  the  inclination  towards  that  side  of  the 
odontoid  process,  the  near  approximation  of  the  transverse 
process  to  the  one  below,  and  the  narrowing  of  the  foramina 
for  the  nerve  and  vertebral  artery.  Posteriorly,  the  bodies  of 
the  second  and  third  cervical  vertebrae  are  anchylosed ; also, 
their  articular  processes,  and  to  some  extent,  the  laminae  upon 
the  left  side.  There  is  no  appearance  of  fracture  or  disloca- 
tion, except  in  the  odontoid  process,  which  may  possibly  have 
been  broken.  The  patient  was  a lady,  seventy-five  years  of 
age,  who  fell  backwards  about  two  years  and  a half  before  her 
death,  and  was  thought  to  have  broken  or  dislocated  her  neck. 
There  was  no  paralysis,  but  for  some  weeks  after  the  accident 
she  was  confined  to  her  bed,  with  great  pain,  and  an  inability 
to  rotate  or  flex  the  head  upon  the  neck ; the  pain  after  a while 
diminished,  but  never  left  her,  and  the  neck  remained  very 
stiff,  the  rotation  being  suddenly  arrested,  as  if  by  some 


DISEASED  BONES. 


35 


mechanical  obstacle,  when  turned  towards  one  side,  though  it 
could  be  freely  turned  in  the  opposite  direction.  From  the 
time  of  the  accident  her  general  health  declined,  and  she  died 
at  last,  from  internal  carcinomatous  disease,  under  the  care  of 
Drs.  H.  B.  C.  Greene  and  Henry  G.  Clark.  1847. 

145.  Caries  of  the  upper  extremity  of  the  sternum,  extending  to 
the  clavicles.  From  an  adult. 

146.  Sternum  of  a child  who  died  from  general  tuberculous  disease. 
One  edge  of  the  bone  is  carious,  and  in  connection  with  it 
there  was  an  abscess  which  was  opened  during  life. 

Dr.  M.  S.  Perry. 

147.  Necrosis  of  the  upper  bone  of  the  sternum.  The  sequestrum 
is  two-thirds  of  an  inch  in  diameter,  or  more,  and  involves  the 
whole  thickness  of  the  bone.  From  a middle-aged  man,  who 
died  at  the  Marine  Hospital,  of  phthisis.  The  disease  of  the 
sternum  was  the  result  of  a blow  which  he  received  some  time 
before  the  pulmonary  disease  began,  there  being,  at  the  time 
of  his  death,  considerable  suppuration  about  the  dead  bone, 
with  an  external  opening.  August,  1844. 

148.  A longitudinal  section  of  the  sternum  and  one  of  the  ribs, 
showing  a cancerous  disease  of  the  bones ; a wet  specimen. 
When  recent,  they  were  filled  with  a reddish,  pulpy,  encepha- 
loid  deposit,  and  in  many  parts  could  be  readily  cut  through 
with  a knife.  In  several  places,  where  the  outer  table  of  the 
bone  was  destroyed,  there  were  found  small  abscesses,  some 
of  which  extended  into  the  pectoral  muscle.  From  a lady, 
aged  sixty-nine,  who  died  of  cancer  of  the  breast,  the  internal 
organs  being  healthy.  1841. 

149.  Transverse  fracture  of  the  upper  bone  of  the  sternum. 

150.  Transverse  fracture  of  the  sternum  opposite  to  the  third  rib. 
From  a man  who  had  fracture  of  the  spine,  &c.,  the  result  of 
a railroad  accident. 

151.  Complete  laceration  of  the  cartilaginous  substance  which 


36 


DISEASED  BONES. 


connects  the  two  upper  bones  of  the  sternum,  but  without  frac- 
ture. Two  or  three  of  the  ribs,  however,  were  fractured,  and 
the  lungs  were  lacerated.  The  patient,  a man  forty-nine  years 
of  age,  fell  from  a barn  window  upon  the  pavement,  about  ten 
feet.  This  happened  in  the  evening,  and  he  laid  there  till  the 
next  morning,  when  he  was  seen  by  Dr.  A.  A.  Gould,  who  sent 
him  to  the  Hospital.  On  the  following  day  emphysema  came 
on,  and  in  the  afternoon  he  died.  A perforation  is  seen  in  this 
specimen,  as  in  No.  37.  1834. 

152.  An  entire  set  of  ribs,  showing  the  existence  of  twenty-seven 
distinct  fractures  in  one  individual ; there  was  also  fracture  of 
the  spine,  &c.  (See  No.  139.)  Many  of  the  bones  are  bro- 
ken in  two  places,  though  some  of  them  are  uninjured.  On 
the  left  side  the  second  rib  is  partially  fractured  near  its  ante- 
rior extremity,  there  being  a simple  transverse  fissure  through 
the  outer  table,  whilst  the  inner  is  but  slightly  bent ; in  the  cor- 
responding part  of  the  third  rib  there  is  the  same  fracture,  but 
the  inner  table  is  more  bent,  whilst  in  the  next  rib  the  fracture 
through  both  tables  is  complete  ; Malgaigne  has  described  par- 
tial fracture  of  the  ribs,  but  in  his  cases  it  was  the  external 
surface  which  was  unbroken.  1838. 

153.  A continuous  fracture  of  eight  successive  ribs,  midway; 

union  strong  but  very  irregular ; a small  exostosis  had  formed 
about  the  seat  of  fracture  in  three  of  them,  and  where  these 
met  a synovial  cavity  was  found,  as  in  the  case  figured  by 
Cruveilhier  (Liv.  xxi.  pi.  3.)  There  is  also  an  appearance  of 
fracture  of  most  of  the  ribs  near  the  angle.  From  the  dis- 
secting room.  Dr.  H.  J.  Bigelow. 

154.  Five  ribs  of  a Dog,  strongly  and  regularly  united  after  fracture. 

Dr.  Jeffries  Wyman. 

155.  Two  ribs  united  laterally,  near  their  anterior  extremity,  by  a 
piece  of  bone  half  an  inch  in  width  and  three-fourths  of  an 
inch  in  length;  some  appearance  of  old  fracture. 

Dr.  George  Parkman. 

156.  Exostosis  from  the  corresponding  edges  of  two  adjoining 


DISEASED  BONES. 


37 


ribs ; the  new  growth  came  together  by  smooth  surfaces,  and 
when  recent,  showed  some  appearance  of  an  articulation. 
The  bones  are  very  light,  from  interstitial  atrophy,  as  were 
others  in  different  parts  of  the  body.  From  the  dissecting 
room.  A similar  appearance  is  figured  by  Cruveilhier,  (Anat. 
Path.  liv.  xxi.  pi.  3.)  1840. 

Dr.  Hammond , of  Nashua,  N.  H. 

157.  Irregular,  old  fracture  of  the  upper  shell  of  a Tortoise  ; one 

portion  remains  detached,  but  the  rest  is  firmly  united.  Recent 
fractures  are  also  seen.  1838.  Dr.  D.  H.  Storer. 

158.  Fracture  with  depression  of  a portion  of  the  shell  of  a Crab ; 

process  of  reparation  shown  by  a new  deposit  upon  the  inner 
surface.  Dr.  J.  B.  S.  Jackson. 

hi.  Upper  Extremity. 

159.  Fibrous  exostosis  of  the  scapula.  Tumors  of  considerable 
size  are  seen  about  the  spine,  consisting  of  very  delicate,  bony 
filaments  radiating  off  from  the  surface  of  the  bone,  from  which 
they  can  in  many  places  be  detached;  surrounded  by  an 
earthy,  periosteal  deposit.  From  the  dissecting  room.  The 
ilium  (No.  197)  was  similarly  affected,  and  also  the  cranium  ; 
this  last  is  in  Dr.  Warren’s  Cabinet.  1834. 

Dr.  J.  B.  S.  Jackson. 

160.  Old  fracture  of  the  scapula  and  two  of  the  ribs  of  a Monkey. 

Dr.  Winslow  Lewis. 

161.  Fragments  of  scapula,  showing  the  effect  of  absorption,  with 
some  periosteal  deposit;  a small  piece  of  bone,  also,  is  in  the 
process  of  being  thrown  off  from  the  humeral  extremity  of  the 
clavicle.  The  patient  received  a wound  from  a grape  shot,  on 
board  of  the  British  frigate  Guerriere ; suppuration  was  very 
extensive,  and  he  died  in  about  two  months. 

Dr.  S.  D.  Townsend. 

162.  Dislocation  of  the  sternal  extremity  of  the  left  clavicle  for- 

wards and  downwards.  From  a case  of  fractured  spine.  (No. 
139.)  1838. 


38 


DISEASED  BONES. 


163.  Fracture  of  the  clavicle  ; union  strong  but  irregular,  a small 

piece  having  been  broken  off  from  one  of  the  principal  frag- 
ments so  as  to  be  felt  quite  loose  beneath  the  skin.  From  a 
man,  aged  forty-four,  who  died  six  months  after  the  accident, 
from  phthisis.  1835.  Dr.  J.  B.  S.  Jackson. 

164.  Fracture  of  the  left  clavicle,  from  a female,  aged  twenty-four. 

1836.  Dr.  M.  S.  Perry. 

165.  Clavicle  of  an  infant,  aged  seven  months.  When  about  two 
months  old  it  met  with  an  accident,  and  fracture  of  the  clavicle 
was  suspected  by  Dr.  H. ; it  was  lame  for  about  a month, 
crying  whenever  the  left  arm  was  touched.  Half  an  inch  from 
its  scapular  extremity  the  bone  is  thicker,  broader,  more 
porous,  and  when  recent,  it  was  more  vascular  than  the  other 
clavicle,  which  is  preserved  for  comparison ; as  the  anterior 
edge  was  unaffected,  it  was  thought  that  the  fracture,  if  there 
had  been  one,  extended  only  partially  through  the  bone.  1839. 

Dr.  Charles  T.  Hildreth. 

166.  Exostosis  from  the  under  surface  of  the  outer  extremity  of  the 
clavicle,  with  old  fracture  of  the  middle  of  the  bone. 

Dr.  M.  S.  Perry. 

167.  Absorption  of  the  cartilage  from  the  head  of  the  humerus. 

Dr.  S.  D.  Townsend. 

168.  Upper  portion  of  the  humerus,  from  a little  girl  who  died  from 

general  scrofulous  disease ; shaft  of  the  bone  very  small,  and 
so  delicate  as  to  have  been  broken  in  handling  the  limb  after 
death.  Dr.  A.  A.  Gould. 

169.  Old  disease  of  the  humerus.  The  bone  is  four  and  one-third 
inches  shorter  than  its  fellow,  which  has  also  been  preserved, 
but,  otherwise,  the  two  are  of  equal  size.  The  disease  was 
limited  to  the  upper  extremity ; the  head  is  broad  and  flattened, 
with  some  exostosis  about  the  edge,  and  is  situated  rather  on 
the  side  than  at  the  extremity  of  the  bone ; neck  wanting. 
The  patient,  aged  thirty-five,  died  at  the  Hospital  of  fracture  of 
the  spine,  August  23d,  1840  (specimen  138) ; he  formerly 


DISEASED  BONES. 


39 


had  a fistulous  opening  over  the  upper  part  of  the  humerus, 
continuing  for  five  years,  and  leaving  a considerable  cicatrix, 
but  it  was  never  ascertained  that  he  had  ever  any  discharge  of 
bone. 

170.  Humeri  of  a Partridge  much  enlarged,  uneven  on  the  surface, 
heavy,  and  very  dense  ; one  of  them,  having  been  sawed 
through  longitudinally,  is  seen  to  consist  of  solid  bone,  the 
cavity  being  entirely  obliterated  ; articular  extremities  healthy ; 
by  the  side  of  these  are  two  healthy  specimens  for  comparison. 
The  bird  was  shot  by  Dr.  C. ; flight  not  remarkable.  The 
other  bones  were  healthy,  so  far  as  observed.  1838. 

Dr.  Samuel  Cabot. 

171.  Small,  irregular  exostosis  on  the  humerus,  about  the  insertion 
of  the  deltoid  muscle.  The  effect  of  a blow  from  a handspike 
about  a year  before  death.  1838.  Dr.  C.  H.  Stedman. 

172.  Dislocation  of  the  humerus.  “ The  accident  happened  at  the 
Navy  Yard,  in  Charlestown,  November  23d,  1841.  A seaman 
was  going  down  a companion  ladder  with  his  hammock  over 
the  left  shoulder,  and  having  the  other  arm  extended  at  right 
angles  from  the  body  with  his  hand  upon  the  hatch  to  steady 
him.  In  this  position  some  one  trod  upon  his  arm  midway 
between  his  shoulder  and  elbow,  and  shot  the  humerus  down 
into  the  axilla.  Several  ineffectual  attempts  having  been  made 
to  reduce  it,  I was  called  in  consultation,  and  adopted  the  plan 
recommended  by  Mr.  White  ; a long  bandage  was  passed  over 
the  shoulder  across  the  back  and  chest  to  the  left  hip,  and  thus 
the  scapula  was  held  perfectly  firm.  The  hand  was  then 
carried  slowly  up,  and  traction  being  made  upwards  in  a line 
with  the  body,  the  reduction  was  at  once  effected.  Thirty  days 
after  the  accident  he  died  of  arachnitis.  On  dissection,  the 
capsular  ligament  was  still  open  at  the  posterior  inferior  part, 
no  attempt  at  reparation  having  been  made.  Several  fibres  of 
the  sub-scapularis  were  ruptured,  and,  upon  cutting  across  this 
muscle,  a quantity  of  pus  escaped.  The  joint  was  filled  with 
pus,  and  the  sub-acromial  bursa  with  purulent  serum.  Between 
these  two  was  a small  opening,  directly  over  the  greater 
tuberosity,  and,  on  passing  a probe,  there  were  felt  some  loose 


40 


DISEASED  BONES. 


pieces  of  bone,  which,  upon  opening  the  joint,  were  found  to 
be  detached  from  this  part  of  the  humerus.”  A portion  of  the 
clavicle,  scapula,  and  humerus  have  been  preserved,  showing 
the  opening  in  the  articular  cavity,  and  the  detachment  of  two 
considerable  pieces  of  bone  from  the  tuberosity. 

Dr.  William  E.  Coale. 

173.  Dislocation  of  the  humerus.  Head  of  the  bone  thrown  com- 
pletely off  from  the  glenoid  cavity,  near  the  edge  of  which 
and  upon  the  under  surface  of  the  scapula  new  bone  has  been 
thrown  out,  and  an  artificial  joint  formed  ; except  for  this  last 
there  seems  to  be  little  or  no  change  in  the  form  of  the  bones, 
though  the  accident  happened  a year  before  death.  The 
patient  retained  considerable  use  of  the  limb. 

Dr.  S.  D.  Townsend. 

174.  Shoulder  joint  completely  destroyed.  The  head  of  the  hume- 
rus and  a large  portion  of  the  scapula  are  absorbed,  leaving 
the  opposing  surfaces  quite  rough  and  irregular.  There  is 
also  a very  oblique,  old  fracture  of  the  upper  half  of  the 
humerus  ; union  strong,  though  a small  opening  is  seen  through 
the  bone.  The  patient  died  of  phthisis  shortly  after  his  admis- 
sion into  the  Marine  Hospital  at  Chelsea,  nothing  being  known 
of  the  disease  of  the  shoulder  till  after  death.  1838. 

Dr.  Charles  H.  Stedman. 

175.  Scapula  and  humerus  of  a Muskrat,  showing  an  entire  de- 

struction of  the  shoulder-joint,  the  bones  being  otherwise 
healthy.  1847.  Dr.  Jeffries  Wyman. 

176.  Old  fracture  of  the  humerus  of  a Fowl.  1839. 

Dr.  Benjamin  E.  Cotting. 

177.  A second  specimen  of  the  same  ; union  very  irregular. 

Dr.  James  Jackson. 

178.  A third  specimen  of  the  same.  One  fracture  is  seen  about 

the  middle  of  the  bone,  united  so  that  the  fragments  make 
quite  an  angle  with  each  other,  and  another,  also  very  irregular, 
near  the  lower  articulation.  Dr.  S.  D.  Townsend. 


DISEASED  BONES. 


41 


179.  A sharp  exostosis,  about  half  an  inch  in  length,  near  the 

middle  of  the  humerus  of  a Fowl,  with  some  appearance  of 
old  fracture.  Dr.  S.  D.  Townsend. 

180.  A compound  fracture  of  the  lower  extremity  of  the  humerus, 
extending  into  the  elbow-joint,  so  as  to  separate  the  condyles. 
A large  irregular  mass  of  new  bone  is  seen  on  the  back  of  the 
outer  condyle  ; lower  portion  of  upper  fragment  of  humerus 
smooth  as  if  it  had  been  denuded,  and  above  this  the  surface 
of  the  bone,  as  far  as  where  it  was  sawn  through,  is  rough 
from  the  new  deposit  and  from  the  action  of  the  absorbents. 
The  accident  happened  at  sea,  and  the  limb  was  amputated  by 
Dr.  S.  at  the  Marine  Hospital,  about  three  weeks  afterwards ; 
the  patient  did  well.  1838.  Dr.  Charles  H.  Stedman. 

181.  Compound  and  comminuted  fracture  of  the  lower  extremity  of 
the  humerus  ; excision  of  the  bone,  as  a substitute  for  amputa- 
tion. The  patient,  a drover,  aged  fifty-three,  of  very  intempe- 
rate habits,  was  thrown  from  his  wagon,  and  struck  his  right 
elbow  upon  the  ground  or  upon  a stone.  The  accident  hap- 
pened at  Brighton,  on  the  25th  of  August,  1845,  at  half  past 
six,  P.  M.,  and  Dr.  Whittemore,  of  that  place,  saw  him  almost 
immediately.  There  was  then  great  pain  in  the  elbow,  with 
considerable  swelling  and  much  crepitus ; the  condyles  were 
shot  forward,  leaving  the  olecranon  process  very  prominent, 
so  as  to  lead  to  the  suspicion  that  the  ulna  was  dislocated  back- 
wards. On  examination,  however,  there  was  found  to  be  a 
fracture  of  the  condyles  of  the  humerus,  and  a compound  and 
comminuted  fracture  of  the  shaft  of  the  bone,  several  loose 
pieces  being  felt  about  the  joint ; the  wound  in  the  skin  was 
half  an  inch  in  length  and  just  above  the  inner  condyle.  On 
the  following  morning  the  patient  was  seen,  in  consultation,  by 
Dr.  William  J.  Walker,  of  Charlestown,  when  it  was  agreed 
to  attempt  the  removal  of  the  loose  pieces  of  bone  and  thus 
save  the  limb ; the  operation  was  conducted  by  Dr.  Walker, 
and  after  a long,  difficult  and  painful  dissection,  the  fragments 
were  disengaged  and  removed  from  the  joint,  and  the  bone 
was  sawed  across  where  the  fracture  commenced,  so  as  to  leave 
its  extremity  comparatively  smooth.  The  limb  was  greatly 
swollen,  and  the  fragments  were  so  displaced  as  to  he  com- 

6 


42 


DISEASED  BONES. 


pletely  wedged  between  the  end  of  the  humerus  and  the  bones 
of  the  fore-arm,  and  thereby  to  render  reduction  impossible, 
the  cavity  of  the  joint,  moreover,  being  extensively  torn  open. 
Immediately  after  the  operation,  the  pain,  which  until  that  time 
had  been  constantly  increasing,  began  to  subside ; the  follow- 
ing night  was  passed  quietly,  and  without  an  opiate : in  the 
morning  the  limb  was  found  less  swollen  and  quite  easy,  and 
from  this  time  forward  he  did  perfectly  well ; the  pulse  was 
fifty-eight  after  the  operation,  and  sixty-two  on  the  second  day, 
when  the  patient  expressed  himself  as  free  from  pain  and  able 
to  walk  abroad.  On  the  7th  of  November,  ten  weeks  and  a 
half  after  the  accident,  he  left  for  home  in  a buggy,  and  safely 
accomplished  his  journey  of  more  than  a hundred  and  thirty 
miles.  He  was  afterwards  occasionally  heard  from,  and  there 
was  every  reason  to  suppose  that  he  would  have  done  well  and 
had  a useful  limb,  had  it  not  been  for  his  intemperance  and 
some  accidents  to  which  this  subjected  him. 

The  fragments  have  been  cemented  together,  and  the  shaft 
of  the  bone  is  thus  seen  to  have  been  fractured  obliquely  down 
to  the  joint,  but  so  as  scarcely  to  involve  the  articular  portion ; 
the  inner  condyle  is  broken  off,  and  there  are  one  or  two  small 
fragments,  besides  others  which  were  not  preserved.  The 
whole  length  of  the  specimen  is  two  inches  and  a third. 

Dr.  William  J.  Walker. 

182.  Ununited  fracture  about  the  middle  of  the  humerus,  several 

large,  irregular  masses  of  bone  having  been  formed  about  the 
fractured  extremities.  The  patient  received  a wound  from  a 
grape-shot,  on  board  of  the  Enterprize,  in  her  action  with  the 
Boxer.  A seton  was  passed,  which  remained  three  months, 
but  without  any  improvement,  the  motion  between  the  bones 
being  quite  free.  -Dr.  S.  D.  Townsend. 

183.  Ununited  fracture  about  the  middle  of  the  humerus;  it  appears 

to  be  rather  shortened,  and  there  is  scarcely  any  deposit  of  new 
bone.  1841.  Dr.  George  C.  Shattuck , Jr. 

184.  Ununited  fracture  about  the  middle  of  the  humerus.  Lower 
fragment  absorbed  nearly  to  the  condyle  ; ligamentary  union, 
in  its  present  dried  condition,  about  two  inches  in  length.  1841. 

Dr.  George  C.  Shattuck , Jr. 


DISEASED  BONES. 


43 


185.  A portion  of  the  humerus  of  a child,  who,  at  the  age  of  eleven 
months,  underwent  amputation  above  the  elbow,  for  a very- 
extensive  and  congenital  encephaloid  disease  of  the  fore-arm. 
The  operation  was  performed  by  Dr.  J.  M.  Warren,  and  the 
child  did  perfectly  well  till  about  three  months  before  death, 
when  there  came  on  dyspncea,  which  increased  so  that  for  the 
last  fortnight  it  could  not  lie  down  in  bed ; the  right  side  of  the 
chest  became  much  enlarged,  but  the  cough  was  not  urgent, 
and  there  was  very  little  constitutional  affection ; the  child  was 
two  years  and  eight  months  old  at  the  time  of  its  death,  and 
had  been  under  the  care  of  Dr.  J.  M.  Whittemore,  of  Brighton. 
On  dissection,  the  right  side  of  the  chest  was  found  distended 
by  large,  solid,  white,  encephaloid  masses,  the  lung  being  very 
little  affected ; the  left  lung  was  more  diseased,  and  from  its 
surface  there  hung  several  pedunculated  masses,  though  the 
whole  amount  of  disease  was  vastly  less  than  on  the  right  side. 
The  axillary  glands  and  stump  were  perfectly  healthy,  and  the 
bone  is  seen  to  be  slender  and  tapering.  May,  1845. 

186.  Disease  of  the  elbow.  Humerus  mostly  affected ; light  as 
from  interstitial  absorption  ; outer  condyle  extensively  carious ; 
for  the  last  three  inches  the  surface  is  irregular,  porous,  and 
granulated.  The  joint  itself  does  not  seem  to  have  been  pro- 
portionally diseased.  Radius  and  ulna  somewhat  diseased  at 
upper  part ; earthy  deposit  on  surface,  with  a few  small,  bony 
granulations  ; some  enlargement  of  ulna.  The  patient  was  a 
negro,  about  twenty-five  years  of  age ; the  disease  was  re- 
garded as  scrofulous,  and  the  limb  was  amputated;  the  knee 
was  afterwards  similarly  affected,  and  the  thigh  was  amputated. 

Dr.  S.  D.  Townsend. 

187.  Disease  of  the  elbow.  Humerus  enlarged  for  three  and  a half 
inches  above  the  condyles,  and  solid  ; the  disease  seems  to  be 
confined  to  the  surface,  which  is  irregular  and  porous  anteri- 
orly, and  covered  with  thick  short  spines  posteriorly.  Radius 
and  ulna  enlarged ; surface  rough ; the  lower  portion  being 
removed  the  cavities  are  seen  to  be  obliterated.  No  caries, 
and  the  articular  surface  of  the  bones  appears  perfectly  healthy 
in  the  dry  specimen.  “ From  a scrofulous  patient  who  had 
had  chronic  diarrhoea  for  two  years,  when  inflammation  and 


44 


DISEASED  BONES. 


enlargement  of  the  elbow-joint  supervened ; the  diarrhoea  then 
ceased,  extensive  sinuses  and  suppuration  formed  about  the 
joint,  and  the  limb  was  amputated ; he  die'd  about  three  months 
afterwards  of  phthisis.”  Dr.  S.  D.  Townsend. 

188.  Disease  of  the  radius  and  ulna,  from  a limb  affected  with 
what  were  regarded  as  scrofulous  ulcers.  Amputation  per- 
formed by  Dr.  S.  above  the  elbow,  and,  secondary  haemorrhage 
having  occurred  on  the  tenth  day,  the  artery  was  tied  in  the 
axilla.  Ulna  considerably  enlarged  throughout,  irregular,  and 
very  rough  on  the  surface;  lower  two-thirds  of  the  radius 
similarly  affected.  Articular  surfaces  apparently  healthy.  1838. 

Dr.  Charles  H.  Stedman. 

189.  Radius  and  ulna  twelve  years  after  amputation ; ends  of  the 
bones  rounded,  with  some  sharp  projections.  Patient  wounded 
on  board  of  the  United  States  frigate  Chesapeake. 

Dr.  S.  D.  Townsend. 

190.  Radius  and  ulna  after  amputation;  ends  rounded  and  quite 

smooth.  Dr.  George  C.  Shattuck , Jr. 

191.  A sequestrum  from  the  ulna;  it  is  six  inches  in  length,  and 
comprises,  to  a great  extent,  the  entire  shaft  of  the  bone.  The 
patient,  a young  man,  eighteen  years  of  age,  entered  the 
Massachusetts  General  Hospital,  February  19th,  1845,  with 
violent  inflammation  of  the  left  fore-arm,  of  a week’s  duration, 
and  which  he  attributed  to  lifting  heavy  plates  of  lead,  his 
business  being  that  of  a printer.  On  the  22d,  an  abscess  was 
opened  near  the  wrist ; on  the  2d  of  April  the  bone  was 
felt  to  be  denuded,  and  on  the  1st  of  May  it  was  slightly 
movable ; on  the  20th  of  May  there  was  a hard,  unequal 
swelling  in  the  situation  of  the  ulna,  denoting  the  formation  of 
a new  bone ; on  the  26th,  a piece  of  bone  about  an  inch  in 
length  was  taken  away,  and,  on  the  17th  of  June,  a large  piece 
was  removed,  being  the  present  specimen,  about  two  inches  of 
new  bone  having  been  divided  by  the  cutting  forceps.  The 
patient  had  suffered  severely  before  the  operation,  but  was 
afterwards  relieved,  and  on  the  14th  of  July  was  discharged 
well. 


DISEASED  BONES. 


45 


192.  Old  fracture  of  radius  and  ulna,  about  midway ; extensively 

anchylosed,  with  shortening,  and  an  inclination  outwards  of  the 
lower  fragments.  1841.  Dr.  George  C.  Shattuck , Jr. 

193.  United  fracture  of  the  radius  and  ulna,  with  a shot  imbedded 
in  one  of  the  bones.  From  a Common  Gallinule,  (Gallinula 
chloropus,)  bought  by  Dr.  C.  in  the  market  at  Paris. 

Dr.  Samuel  Cabot. 

194.  Old  fracture  of  the  lower  extremity  of  the  radius  less  than  an 
inch  above  the  articulation;  strongly  reunited,  but  overlaps 
considerably.  From  an  adult.  1841. 

Dr.  George  C.  Shattuck , Jr. 

195.  Upper  portion  of  the  ulna  irregularly  fractured,  and  splintered 
longitudinally.  Probably  the  effect  of  a gun-shot  wound. 

196.  The  anterior  extremity  of  a Sheep,  showing  an  exostosis,  of 
the  size  of  a large  horse-chestnut,  arising  from  the  inner  edge 
of  the  carpus ; several  of  the  carpal  bones  are  more  or  less 
affected,  and  the  whole  limb  below  this  part  is  directed  inwards  ; 
the  articular  surface  of  the  head  of  the  humerus  is  somewhat 
eburnated. 

iv.  Lower  Extremity. 

197.  Fibrous  exostosis  of  the  os  innominatum:  the  scapula  was 
similarly  diseased  (No.  159.)  Near  the  acetabulum  the  bone 
is  thickened,  and  the  surface  granulated  and  porous. 

Dr.  J.  B.  S.  Jackson. 

198.  Fracture  through  the  rami  of  the  ischia  and  ossa  pubis  on 
both  sides.  From  a man  who  was  run  over  by  a loaded  wagon, 
and  died  on  the  following  day.  1838. 

Dr.  Charles  H.  Stedman. 

199.  Gun-shot  wound  of  the  os  innominatum,  with  the  upper  half  of 
a femur,  which  seems  to  have  been  amputated.  These  two 
bones,  which,  from  the  position  in  which  they  were  found, 
probably  belonged  to  the  same  individual,  were  dug  up  at 


46 


DISEASED  BONES. 


Mont  St.  Jean,  Waterloo,  a place  where  several  hundred  of 
the  French  are  said  to  have  been  buried  after  the  battle. 

Dr.  J.  B.  S.  Jackson. 

200.  A portion  of  the  hip-bone  and  femur,  showing  the  effects  of 
an  injury  which  was  received  probably  at  the  time  of  birth. 
The  patient  was  a married  lady,  fifty-nine  years  of  age,  and 
died,  under  the  care  of  Dr.  Homans,  of  chronic  abdominal 
disease,  in  August,  1840.  When  about  fifteen  months  old  a 
lameness  was  first  noticed,  and  it  was  then  remembered  that 
she  received  a fall  at  the  time  of  her  birth,  which  took  place 
so  suddenly  that  she  was  expelled  and  fell  upon  the  floor  before 
any  assistance  could  be  given ; no  appearance  of  injury,  how- 
ever, was  then  discovered.  With  the  lameness  there  was  a 
shortening  of  the  limb,  but  no  pain  on  motion  or  pressure,  and 
her  general  health  was  quite  good.  As  she  grew  up  the  short- 
ening increased,  until  she  arrived  at  the  age  of  twenty  years, 
from  which  time  she  wore  a shoe  which  raised  the  limb  about 
four  inches,  but  even  that  did  not  give  it  the  same  length  as  the 
other.  The  foot  was  neither  turned  in  nor  out.  In  her  habits 
she  was  very  active,  playing,  when  a child,  as  freely  as  others 
of  her  age,  and  always  walking  with  as  much  ease  and  as 
rapidly  as  any  one ; the  head  of  the  femur,  however,  was 
alternately  raised  and  depressed  as  she  walked,  so  that,  in  her 
latter  years,  she  was  in  the  habit  of  supporting  the  hip  with 
her  hand.  On  examination  after  death,  the  shortening  of  the 
left  lower  extremity  was  found  to  be  about  four  or  five  inches. 
The  acetabulum  is  seen  to  be  small,  irregular  and  shallow,  and 
the  dorsum  of  the  ilium  somewhat  hollowed,  but  without  the 
least  appearance  of  a new  socket.  About  one-third  part  of 
the  head  of  the  femur  remains,  irregularly  flattened  on  the 
surface  opposed  to  the  ilium,  but  about  the  circumference 
retaining  somewhat  of  its  usual  form ; the  neck  is  much  short- 
ened. In  structure  both  the  bones  have  their  usual  density, 
and  there  is  no  appearance  of  eburnation,  exostosis,  or  caries. 
The  first  examination  was  very  hastily  made,  and  it  was  only 
observed,  with  regard  to  the  connection  between  the  bones, 
that  the  cavity  of  the  acetabulum  was  filled  with  a fibro-cellular 
substance,  and  that  there  was  a large  bursa  or  synovial  cavity 
near  it.  The  nature  of  the  case  is  doubtful ; there  may  have 


DISEASED  BONES. 


47 


been  a simple  contusion  of  the  hip,  followed  by  disease  of  the 
joint,  but  it  is  supposed,  on  the  whole,  that  there  must  have 
been  a dislocation  at  the  time  of  birth. 

201.  Caries  of  the  acetabulum  and  head  of  the  femur,  from  a case 
of  hip-disease.  The  patient  was  a sailor,  aged  twenty-four ; 
the  disease  began,  without  any  obvious  cause,  whilst  he  was  at 
sea,  in  the  autumn  of  1842;  he  continued  to  do  duty  till  the 
following  June,  and  arrived  here  in  September.  At  that  time 
he  was  pretty  comfortable,  and  could  walk  some  distance,  but, 
falling  into  the  hands  of  an  empiric,  he  was  subjected  to  very 
severe  treatment,  which  brought  on  great  pain  in  the  joint.  In 
October  he  entered  the  Hospital ; the  pain  then  continued,  and 
there  was  flattening  of  the  right  nates,  with  eversion  of  the 
foot,  but  without  any  perceptible  shortening  of  the  limb.  The 
pain  was  after  a while  relieved,  but  about  the  first  of  January 
symptoms  of  phthisis  came  on,  and  he  died  April  6th,  1844. 
Besides  the  disease  of  the  lungs,  there  was  found  a very  ex- 
tensive abscess,  communicating  largely  with  the  hip-joint,  and 
nearly  filled  with  a coarse,  pultaceous  mass,  the  articulating 
surfaces  of  the  bones  being  perfectly  denuded. 

202.  Disease  of  the  hip-joint.  Cavity  of  the  acetabulum  enlarged 
upwards  and  backwards,  with  a deposit  of  new  bone  externally. 
The  cartilage  seems  to  have  been  entirely  destroyed,  leaving 
exposed  the  rough  surface  of  the  bones,  which,  when  soaked 
for  a few  moments  in  water,  look  and  feel  like  soft  sponge. 
Nearly  the  whole  of  the  ilium,  also,  on  being  soaked,  becomes 
quite  flexible  ; bone  very  light,  having  lost  a great  deal  of  its 
earthy  matter.  Head  of  the  femur  of  its  usual  size,  but  below 
this  the  bone  is  somewhat  enlarged  and  dense.  “ The  result 
of  inflammation,  brought  on  by  the  patient’s  pumping  very 
laboriously  when  in  danger  of  shipwreck.” 

Dr.  S.  D.  Townsend. 

203.  Disease  of  the  hip-joint.  “ The  patient  died  about  two  years 
from  the  commencement  of  the  disease,  hectic ; femur  dislo- 
cated ; round  ligament  destroyed.”  Disease  on  the  left  side. 
Head  of  femur  partially  absorbed ; surface  rather  spongy, 
except  in  one  spot  where  it  is  eburnated.  Acetabulum  much 


48 


DISEASED  BONES. 


enlarged  upwards  and  backwards,  being  almost  destroyed  in 
this  direction,  but  with  some  thickening  of  the  surrounding 
bone ; inner  surface  rough,  and  about  its  centre  is  an  irregular 
cavity,  in  which  is  a piece  of  bone  eburnated  and  partly 
detached.  Dr.  S.  D.  Townsend. 

204.  Disease  of  the  hip-joint.  From  a patient  who  had  caries  of 
the  spine  (No.  118.)  Disease  of  hip  first  noticed  about  six 
months  before  death ; there  was  swelling  with  great  induration 
and  at  last  suppuration ; numerous  abscesses  opened,  and  the 
discharge  was  profuse ; pain  very  severe ; limb  much  short- 
ened at  the  time  of  death,  and  surface  of  great  trochanter 
exposed.  Disease  on  right  side,  the  os  innominatum  and 
femur  being  about  equally  affected.  Head  of  femur  and  a 
considerable  part  of  the  neck  absorbed.  Acetabulum  almost 
entirely  destroyed.  Surfaces  rough  from  caries,  with  some 
deposit  of  new  bone  upon  the  surrounding  parts.  The  sinuses 
about  the  hip  were  very  extensive.  1837. 

205.  Os  innominatum  of  left  side,  showing  great  enlargement  of 

the  acetabulum  upwards  and  backwards,  with  caries  of  inner 
surface.  From  a lad  aged  ten  years.  Disease  caused  by  an 
injury  received  when  he  was  about  two  years  old  ; confined  for 
some  weeks,  but  had  very  little  done  for  him.  Was  afterwards 
in  the  habit  of  playing  about,  suffering  all  the  while  from  pain 
in  the  knee,  but  in  no  other  part.  Four  or  five  years  after- 
wards he  had  sudden  and  severe  pain  in  hip,  with  cramps  in 
the  whole  limb.  In  March,  1834,  he  entered  the  Alms-house, 
and  was  there  confined  to  his  bed  for  some  months,  with  much 
pain  and  constitutional  affection;  fistulous  openings  after  a 
while  formed,  and  he  had  a constant  discharge  of  pus  from 
about  the  hip  ; after  some  months  he  was  able  to  get  about  on 
crutches  and  to  go  out  of  doors.  For  the  last  six  or  eight 
months  he  made  no  complaint  of  pain  in  the  hip,  and  was 
tolerably  comfortable,  though  generally  failing;  his  appetite 
was  voracious,  and  the  immediate  cause  of  his  death  was  im- 
prudence in  diet.  Dr.  M.  S.  Perry. 

206.  Complete  bony  anchylosis  of  the  hip-joint.  The  femur  is 
quite  small,  probably  from  disuse  of  the  limb.  The  bone. 


DISEASED  BONES. 


49 


however,  is  hard  and  compact,  contrasting  with  the  interstitial 
atrophy,  from  the  same  cause  as  observed  in  some  of  the 
other  specimens. 

207.  Complete  bony  anchylosis  of  the  hip-joint ; the  other  joint  was 
similarly  affected,  as  was  also  the  spine  from  the  neck  down- 
wards ; the  other  joints  were  free.  From  a gentleman,  aged 
thirty-seven  years,  a patient  of  Dr.  S.  D.  Townsend.  About 
ten  years  before  death  he  began  to  have  rheumatism,  and 
suffered  more  or  less  severely  for  some  years,  but  none  for  the 
last  five  or  six.  The  disease  left  him  a most  remarkable 
cripple  ; for  a long  while  before  death,  the  trunk  was  bent  to  a 
right  angle  with  the  thighs  when  he  walked,  and  in  carrying 
forward  one  of  the  lower  extremities  it  was  at  the  same  time 
carried  inwards,  and  the  whole  body  seemed  to  follow  the 
motion.  Died  of  phthisis ; the  lungs  were  extensively  tuber- 
culous, and  there  was  also  Bright’s  disease  of  the  kidneys, 
though  there  was  no  dropsy.  1839. 

208.  Right,  femur  diseased  in  consequence  of  an  extensive  abscess 

of  the  thigh ; amputated  above  the  middle  of  the  bone,  by 
Dr.  S.  Lower  extremity  healthy,  or  nearly  so,  but  the  bone  soon 
became  enlarged,  and  arched  forwards  ; surface  rough,  but  no 
proper  caries ; where  it  was  sawed  through  it  has  become 
smaller,  is  flattened  laterally,  and  the  central  cavity  is  oblite- 
rated. Probably  the  effect  of  simple  inflammation.  The 
patient  did  well.  1838.  Dr.  Charles  H.  Stedman. 

209.  Lower  end  of  femur  enlarged  for  three  and  a half  inches 
above  the  joint,  and  carious. 

210.  A sequestrum  from  the  femur,  three  inches  in  length,  rough 
on  the  surface,  and  involving  about  one  half  the  circumference 
of  the  bone.  The  patient  was  a healthy  farmer,  twenty-one 
years  of  age,  and  had  had  the  disease  for  eight  years  ; it  came 
on  with  acute  inflammation,  on  the  inside  of  the  thigh,  after  an 
attack  of  fever,  and  was  soon  followed  by  a similar  affection  of 
the  left  arm,  from  which  a piece  of  bone  was  discharged  in  about 
two  years.  The  present  specimen  was  removed  at  the  Massa- 
chusetts General  Hospital,  July  25th,  1845. 

7 Dr.  S.  D.  Townsend. 


50 


DISEASED  BONES. 


211.  A sequestrum,  nearly  three  inches  in  length,  from  the  right 
femur.  The  patient  was  a young  woman,  nineteen  years  of 
age,  and  apparently  in  good  health.  At  the  age  of  five  years 
she  had  a “ fever,”  and  at  different  times  since  then  had  dis- 
charged pieces  of  bone  from  the  right  femur,  tibia,  and  hume- 
rus, and  from  the  lower  jaw,  which  is  now  anchvlosed.  1845. 

Dr.  William  E.  Coale. 

212.  Exfoliation  of  the  os  femoris  about  eight  months  after  ampu- 
tation. It  is  eight  inches  in  length,  thick  in  the  centre,  but 
thin  towards  the  edges,  comprising  for  the  most  part  the  ante- 
rior half,  but  at  the  very  lower  end  the  entire  calibre,  of  the 
bone.  Amputation  performed  from  injury  the  patient  received 
during  the  action  between  the  Constitution  and  the  Java. 

Dr.  S.  D.  Townsend. 

213.  Upper  portion  of  the  femur,  showing  the  neck  much  shortened, 
with  ragged  exostosis  about  the  head  of  the  bone. 


214.  Upper  third  of  the  femur,  showing  an  exostosis  about  the  neck, 
which  was  regarded  by  many,  who  saw  the  specimen  before  it 
was  sawed  open,  as  the  result  of  fracture,  the  same  mistake 
having  probably  been  made  in  some  of  the  alleged  cases  of 
intra-capsular  union ; neck  not  otherwise  altered ; head  pecu- 
culiarly  elongated  or  ovoid.  1840. 

Dr.  Hammond , of  Nashua,  N.  H. 

215.  Exostosis  from  the  anterior  face  of  the  shaft  of  the  femur 
about  midway ; a thick,  solid  ridge  of  bone,  two  and  a half 
inches  in  length,  and  bent  over,  so  that  the  sharp  edge  in  which 
it  terminates  looks  towards  the  inside  of  the  limb.  Bone 
otherwise  perfectly  sound,  though  it  came  from  the  same  sub- 
ject as  specimens  159  and  197.  Dr.  J.  B.  S.  Jackson. 

216.  Abrupt  and  very  marked  curvature  backwards  just  above  the 

condyles  of  the  femur ; articular  surface  irregular.  Bone 
otherwise  well.  1841.  Dr.  George  C.  Shattuck , Jr. 

217.  Large,  dense,  knobbed,  and  apparently  fibro-cartilaginous 
tumor  encircling  the  lower  third  of  the  femur,  but  not  involv- 


DISEASED  BONES. 


51 


ing  the  joint;  the  specimen  is  preserved  in  spirit,  and  has  not 
been  sawed  open.  The  patient  was  a young  man,  sixteen 
years  of  age,  and  of  a delicate  constitution  ; the  disease  came 
on  without  any  obvious  cause,  in  the  autumn,  about  the  year 
1828,  and  was  regarded  by  Dr.  Walker  as  osteo-sarcoma  ; 
the  limb  was  amputated  in  the  spring,  and  the  patient  died  in 
the  autumn  following. 

Dr.  William  J.  Walker , of  Charlestown. 

218.  Disease  of  the  lower  portion  of  the  femur,  regarded  by  Dr. 

S.  as  osteo-sarcoma.  It  commences  just  above  the  joint,  and 
extends  upwards  six  or  seven  inches  ; a large  and  very  irregu- 
lar mass  of  light,  porous,  imperfectly  formed  bone  is  seen, 
arranged  in  part  in  radiating  fibres,  and  seeming  to  arise  mostly 
from  the  surface  of  the  bone ; anterior  and  inner  surface 
mostly  affected ; in  the  recent  state  the  cavities  in  the  new 
bone  are  said  to  have  contained  blood  ; the  disease  is  pretty 
well  defined,  the  articular  surface  appearing  healthy.  The 
limb  was  amputated  at  the  Marine  Hospital,  and  the  patient 
did  well.  1838.  Dr.  Charles  H.  Stedinan. 

219.  Femur  from  a cancerous  subject.  The  bone  is  now  in  three 
pieces,  a great  part  of  it  having  been  absorbed  ; outer  surface 
in  many  places  a mere  reticulated  shell ; the  extremities  retain 
their  form,  but  have  lost  much  by  interstitial  absorption. 
“ From  a patient,  sixty  years  of  age,  who  died  of  cancer  of 
the  breast ; the  femur  was  broken  by  merely  laying  the  thigh 
over  the  side  of  the  bed  ; probably  all  the  bones  in  the  body 
were  in  this  state,  as  they  could  be  broken  with  the  greatest 
ease.”  A large  portion  of  the  cranium  (No.  97)  and  lower 
jaw  are  in  the  Cabinet ; also  the  breast,  and  a scirrhous  ovary. 

Dr.  S.  D.  Townsend. 

220.  Two  femora,  which  appear  to  have  belonged  to  the  same  sub- 
ject, showing  the  rounding  of  the  bones  after  amputation,  and 
also  the  result  of  interstitial  atrophy  from  disuse ; they  are 
very  light,  though  of  full  size,  the  left  being  somewhat  en- 
larged ; bony  spine  on  each  extremity.  1841. 

Dr.  George  C.  Shattuck , Jr. 


52 


DISEASED  BONES. 


221.  Transverse  fracture  of  left  femur,  about  midway  ; the  patient 
died  of  delirium  tremens  on  the  third  day.  1838. 

Dr.  Charles  H.  Stedman. 

222.  “ Fragments  of  bone  from  the  femur  of  one  of  the  crew  of 

the  British  frigate  Guerriere,  who  received  a compound  frac- 
ture from  a cannon  ball,  in  the  action  of  that  frigate  with  the 
Constitution ; result  fatal.”  Dr.  S.  D.  Townsend. 

223.  Spontaneous  fracture  of  the  femur  through  or  just  below  the 

great  trochanter  ; the  upper  extremity  of  the  bone,  the  only 
part  preserved,  is  very  light  and  spongy.  From  a female  past 
the  middle  period  of  life,  and  affected  with  rheumatism  : she 
lived  for  some  time  after  the  accident,  but  there  was  no  attempt 
at  union.  Dr.  Martin  Gay. 

224.  Fracture  of  the  neck  of  the  femur  from  senile  atrophy.  The 
patient,  a female  aged  eighty-seven,  fell  without  any  known 
cause,  as  she  was  walking  across  the  room.  From  the  27th 
of  November,  1838,  when  the  accident  happened,  till  her 
death,  on  the  11th  of  the  following  August,  she  occasionally 
sat  up,  but  had  to  be  lifted  in  and  out  of  bed,  and  was  never 
willing  to  bear  any  weight  upon  the  lame  foot ; never  any 
pain  except  when  splints  were  tried,  and  these  could  not  be 
borne  ; lost  much  flesh,  having  previously  been  very  corpu- 
lent. After  death  the  limb  was  found  turned  very  much  out- 
wards, and  in  this  position  measured  from  half  an  inch  to  an 
inch  shorter  than  the  other,  though  the  difference  appeared 
very  much  less  when  rotated  inwards.  The  upper  third  of  the 
femur  only  is  preserved  ; fracture  through  the  neck  mostly,  if 
not  altogether  external  to  the  capsule ; a large  portion  of  the 
great  trochanter  is  also  broken ; union  of  both  sufficiently  firm. 

Dr.  Z.  B.  Adams. 

225.  Fracture  of  the  femur;  the  great  trochanter  is  broken  entirely 
off,  and  also  the  neck  at  its  connection  with  the  shaft  of  the 
bone  ; union  slight.  The  bone  has  been  sawn  through  longitu- 
dinally. The  patient,  a lady,  seventy-five  years  of  age,  re- 
ceived the  injury  by  slipping  from  a chair  as  she  stooped  on 
one  knee  to  pick  something  from  the  floor ; this  was  on  the 


DISEASED  BONES. 


53 


6th  of  January,  1841,  and  she  died  on  the  3d  of  the  following 
March,  from  sloughing  of  the  nates;  the  limb  turned  in,  and 
was  very  little  shortened.  Dr.  Edward  Reynolds. 

226.  Oblique  fracture  of  the  femur  just  below  the  great  trochanter  ; 

the  small  trochanter  is  also  broken  off;  union  irregular.  From 
an  old  woman  who  died  at  the  Alms-house  in  the  year  1840  ; 
the  accident  happened  eighteen  months  previously,  and  she 
kept  her  bed  from  that  time,  resisting  all  treatment,  the  limb 
being  very  much  shortened,  and  the  knee  always  in  a bent 
position.  Dr.  William  T.  Parker. 

227.  Fracture  of  the  upper  part  of  the  left  femur  ; union  strong, 
but  very  irregular.  The  shaft  of  the  bone  seems  to  have  been 
broken  just  below  the  small  trochanter,  and  the  whole  of  the 
great  trochanter  has  been  broken  from  the  neck.  Head  of  the 
bone  much  flattened,  and  the  surface  quite  rough.  1841. 

Dr.  George  C.  Shattuck,  Jr. 

228.  Ununited  fracture  of  the  head  of  the  femur.  “ From  a patient 

who  died  in  June,  1838,  at  the  age  of  eighty-seven.  About 
four  or  five  years  before  his  death  he  fell  on  the  ice.  He 
was  unable  to  rise  or  move  the  hip-joint,  or  have  it  moved 
without  great  suffering.  There  was  no  shortening  of  the 
limb,  turning  out  of  the  toes,  nor  perceptible  crepitus.  Con- 
siderable inflammation  and  pain  followed  ; then  finally  subsi- 
ded, but  he  was  never  able  to  bear  any  weight  on  that  leg. 
The  ligaments  appeared  not  to  have  been  much  injured.  The 
ball  was  attached  by  the  round  ligament  to  the  bottom  of  the 
acetabulum.  The  capsular  ligament  was  attached  naturally  to 
the  margin  of  the  acetabulum  and  the  neck  of  the  femur. 
The  cavity  of  the  joint  contained  a fluid  resembling  veiy  thick 
pus.”  Dr.  Robert  Tliaxter , of  Dorchester. 

229.  Ununited  fracture  of  the  neck  of  the  femur.  A portion  of 
the  os  innominatum  is  preserved,  with  the  upper  third  of  the 
femur.  The  head  of  the  bone  is  detached,  but  almost  entire ; 
the  neck  is  absorbed,  and  even  a part  of  the  shaft,  two  small, 
eburnated  spots  being  seen  on  this  last.  The  bones  are  very 
light,  as  from  interstitial  atrophy,  the  effect  of  long  disuse. 


54 


DISEASED  BONES. 


From  a man,  fifty-six  years  of  age,  who  died  at  the  Alms- 
house, where  he  had  been  for  eight  or  ten  years,  having  met 
with  the  accident  before  his  entrance.  On  examination  after 
death,  the  right  lower  extremity  was  found  shortened  about  an 
inch  and  a half,  the  foot  turned  somewhat  outwards,  and  the 
head  of  the  bone  could  be  moved  freely  forward  and  back, 
with  a sort  of  crepitus,  the  synovial  cavity  being  much  en- 
larged. The  head  of  the  bone  adhered  to  the  fossa  about  the 
round  ligament,  and  the  cartilage  was  partially  absorbed. 
There  were  also  found  in  this  subject  exostoses  about  the 
bodies  of  the  vertebra;,  with  partial  anchylosis,  adhesion  of  the 
dura  mater,  extensive  meningeal  apoplexy,  and  parasites 
(Trichina  spiralis)  in  the  voluntary  muscles.  1842. 

Dr.  M.  W.  Weld. 

230.  Spontaneous  fracture  of  the  upper  third  of  the  femur,  from  a 

cancerous  subject.  The  union  is  very  irregular,  and  a large, 
thin  shell  of  new  bone,  of  a flattened,  oval  form,  is  developed 
about  the  upper  fragment ; contents  of  this  not  ascertained,  as 
the  bone  was  not  sawed  open  until  after  it  had  been  macerated. 
Upper  fragment  atrophied,  but  not  the  lower.  The  patient, 
aged  fifty,  had  a cancer  of  the  breast  removed  at  the  Hospital 
in  July,  1838.  Four  months  afterwards,  whilst  sitting  at  her 
fire-side,  she  was  suddenly  seized  with  severe  pain  in  the  right 
thigh  ; thought  it  rheumatic,  and  immediately  sent  for  Dr.  Hay- 
ward, but  never  allowed  an  examination  of  the  limb.  The 
pain  gradually  subsided,  and  in  the  course  of  six  or  eight 
weeks  she  was  able  to  get  up  and  support  herself  by  sewing 
till  the  week  before  her  death,  which  occurred  February  12th, 
1837.  On  dissection,  besides  the  fracture,  there  was  found 
extensive  scirrhus  of  the  stomach,  disease  of  the  uterus,  and 
ascites.  Dr.  George  Hayward. 

231.  Old  fracture  about  the  middle  of  the  femur  ; pretty  regular 
union,  though  the  accident  happened  at  sea. 

Dr.  S.  D.  Townsend. 

232.  Very  oblique  fracture  of  the  femur,  about  midway ; union 
strong,  though  there  seems  to  be  some  shortening.  From  a 
man  about  fifty  years  of  age,  who  died  of  cancer  of  the 
tongue  in  May,  1839.  Dr.  Andrew  Nichols , of  Danvers. 


DISEASED  BONES. 


55 


233.  Old  fracture  of  the  left  femur,  about  midway.  The  bones 
overlap  more  than  an  inch  ; and  are  inclined  outwards ; bony 
spine,  an  inch  in  length,  at  seat  of  fracture.  1841. 

Dr.  George  C.  Shattuck , Jr. 

234.  Transverse  fracture  of  the  left  femur,  at  the  junction  of  the 
middle  and  lower  thirds ; union  strong,  though  the  bones  over- 
lap nearly  two  inches.  Sawed  longitudinally,  and  shows  the 
external  hard  part  of  the  bone  at  the  seat  of  the  fracture 
becoming  cancellated.  The  patient  was  a laboring  man,  aged 
forty -four,  and  was  treated  according  to  Dessault’s  plan ; lived 
twenty  months  after  the  accident,  which  occurred  in  May, 
1836,  and  was  carried  after  death  to  the  dissecting  room, 
where  the  specimen  was  obtained  by 

Dr.  Winslow  Lewis. 

235.  Compound  fracture  of  the  lower  part  of  the  femur,  extending 

into  the  knee-joint  so  as  to  separate  the  condyles.  The  lower 
extremity  of  the  upper  fragment  seems  to  have  been  exposed, 
the  surface  being  quite  smooth  to  the  extent  of  from  two  to 
twelve  lines;  immediately  above  this  there  is  considerable 
absorption  of  the  bone  with  a strong  line  of  demarcation,  and 
the  whole  surface,  as  far  up  as  where  it  was  sawed  through,  is 
filled  with  small  pores,  from  an  enlargement  of  the  nutrient 
vessels,  and  in  some  places  is  rough  from  a new  deposit.  The 
accident  happened  at  sea,  and  the  limb  was  amputated  by 
Dr.  S.  at  the  Marine  Hospital  about  eight  weeks  afterwards ; the 
man  did  well.  1838.  Dr.  Charles  H.  Stedman. 

236.  Old  fracture  of  the  right  femur  about  the  union  of  the  middle 

and  lower  thirds.  Lower  fragment  very  much  diseased  ; the 
bone  is  very  light,  friable,  reduced  in  part  to  a mere  shell,  and 
to  a considerable  extent  is  entirely  destroyed,  though  this  last 
may  have  been  accidental ; the  cause  of  this  great  absorption  is 
uncertain,  as  nothing  is  known  of  the  history  of  the  case.  The 
upper  fragment  is  quite  sound,  and  the  union  is  strong,  though 
very  irregular.  1841.  Dr.  George  C.  Shattuck , Jr. 

237.  Old  fracture  of  the  left  femur  just  below  the  small  trochanter  ; 
strongly  united.  The  upper  fragment  is  about  four  inches  in 


56 


DISEASED  BONES. 


length,  and  terminates  superiorly  in  a smooth,  blunt  extremity, 
showing  no  trace  of  the  head  nor  even  of  the  neck  of  the 
bone,  the  great  trochanter,  however,  being  sufficiently  distinct ; 
this  may  have  been  the  result  of  an  ununited  fracture  of  the 
neck.  1841.  Dr.  George  C.  Shattuck,  Jr. 

238.  Fracture  of  the  femur  of  a Fowl,  midway  ; union  very  regu- 
lar. Dr.  S.  D.  Townsend. 

239-40.  Two  other  specimens;  union  strong,  but  very  irregular. 

241.  Fracture  of  the  femur  of  a Goose,  midway ; the  fragments 
overlap  by  nearly  their  whole  length,  and  the  union  is  slight. 

Dr.  S.  D.  Townsend. 

242.  Disease  of  the  knee-joint.  Deep  excavations  are  seen  in  the 

head  of  the  tibia  and  fibula,  and  about  the  inner  condyle  of  the 
femur,  with  similar  disease  of  the  patella.  A periosteal  de- 
posit, upon  the  inside  of  the  femur,  is  well  shown  where  the 
bone  was  sawed ; there  is  a mass  of  new  bone,  also,  on  the 
inner  condyle,  about  half  an  inch  in  diameter,  and  the  surface 
of  the  bones  generally,  about  the  joint,  is  rough  and  porous. 
The  patient  injured  his  knee  by  falling  on  the  ice ; extensive 
suppuration  ensued,  and  the  limb  was  amputated  several 
months  after  the  accident.  Dr.  S.  D.  Townsend. 

243.  Disease  of  the  knee-joint ; the  cartilage  seems  to  have  been 

entirely  destroyed,  with  caries  of  the  articular  surface  of  the 
bones.  The  disease  had  existed  for  ten  or  twelve  years.  For 
the  first  two  years  there  was  stiffness  with  some  pain,  and  at 
one  time  the  patient  was  confined  by  an  abscess  about  the 
knee,  which  was  very  painful,  but  did  not  seem  to  involve  the 
bone.  He  then  went  to  New  Orleans,  and  remained  there  for 
six  or  seven  years,  during  which  time  the  knee  was  nearly 
well.  On  his  return  to  this  city  the  disease  became  worse  than 
ever,  and  for  a long  while  he  was  confined  with  much  local 
and  constitutional  affection.  Amputation  was  then  performed 
by  Dr.  Strong,  after  which  his  health  was  fully  restored,  and 
with  the  aid  of  an  artificial  limb  he  is  able  to  keep  about  and 
perform  the  duties  of  book-keeper  in  one  of  the  Banks  in  this 
city.  1838.  Dr.  Woodiridge  Strong. 


DISEASED  BONES. 


57 


244.  Disease  of  the  knee-joint.  The  articular  surface  of  the  bones 
is  carious,  though  not  extensively  so,  and  a fragment  of  con- 
siderable size  is  in  the  process  of  being  detached  from  the 
head  of  the  fibula.  The  patient  was  a young  man,  aged  nine- 
teen. Disease  of  about  two  years  duration,  and  followed  a 
blow ; came  on  insidiously,  and  when  first  seen  in  October,  1837, 
the  knee  was  much  enlarged,  and  so  much  diseased  that  there 
seemed  very  little  chance  of  saving  the  limb.  Sinuses  at  last 
formed,  the  constitution  failed,  and  it  was  not  till  then  that  he 
had  much  pain.  Amputation  was  performed  by  Dr.  M’K.  in 
July,  1838,  and  the  patient  regained  his  usual  health. 

Dr.  J.  W.  M' Kean. 

245.  Disease  of  the  knee-joint,  coming  on  about  a year  after  frac- 
ture of  the  leg ; the  limb  was  amputated  by  Dr.  Stedman,  and 
the  patient  did  well.  The  back  part  of  the  femur  is  rough 
from  a new  deposit  as  high  up  as  where  it  was  sawed  through. 
The  inner  condyle  is  enlarged  and  rough,  and  the  articular 
surface  of  this  condyle,  to  the  extent  of  one  inch  and  a third 
by  two  thirds  of  an  inch,  is  eburnated,  and  perfectly  free  from 
fat,  with  which  the  surrounding  bone  is  saturated ; remainder 
of  the  articular  surface  of  the  femur  somewhat  rough,  though 
it  does  not  seem  to  have  been  much  diseased.  The  articular 
surface  of  the  tibia  is  much  more  carious,  especially  towards  the 
inside.  The  fracture  of  the  tibia  is  irregular,  commencing 
about  two  and  a half  inches  below  the  joint,  and  extending  to 
below  the  middle  of  the  bone;  union  strong,  but  such  as  to 
leave  the  anterior  line  of  the  bone  concave ; upper  extremity 
of  the  fibula  fractured,  and  strongly  united.  1838. 

Dr.  Charles  H.  Stedman. 

246.  Disease  of  the  knee-joint,  with  an  old  fracture  of  the  upper 
third  of  the  tibia  and  fibula.  Articular  surfaces  irregular,  with 
some  traces  of  eburnation  ; lower  extremity  of  femur  fringed 
with  exostoses,  and  some  of  the  same  about  the  tibia ; surface 
of  fibula  also  rough  from  osseous  spines  and  knobs.  1841. 

Dr.  George  C.  Shattuck , Jr. 

247.  Complete  bony  anchylosis  of  the  knee-joint,  except  for  a small 
opening  through  the  centre.  There  is  deep  and  extensive 

8 


58 


DISEASED  BONES. 


caries  upon  the  inside,  and  the  femur  is  enlarged  and  uneven 
upon  the  surface;  patella  anchylosed, and  partially  absorbed. 
Joint  bent  to  an  angle  of  about  one  hundred  degrees. 

Dr.  George  Parkman. 

248.  Specimen  similar  to  the  last,  but  in  which  the  bones  are  per- 
fectly sound ; the  opening  through  the  centre  of  what  was 
formerly  the  joint  is  larger  than  in  the  other  case. 

Dr.  George  Parkman. 

249.  Complete  bony  anchylosis  between  the  inner  condyle  of  the 
femur  and  the  head  of  the  tibia,  the  outer  condyle  and  the 
patella  being  free.  From  a man,  aged  twenty-five,  who  died 
of  phthisis  at  the  Massachusetts  General  Hospital,  November 
27,  1842;  ten  years  before,  he  had  wounded  the  right  knee- 
joint  with  an  axe ; never  had  any  discharge  of  bone  ; knee 
bent  nearly  to  a right  angle. 

In  the  next  division  is  a specimen  of  fleshy  anchylosis  of  the 
knee-joint,  which  might  perhaps  have  been  introduced  here. 

250.  Portion  of  the  bones  of  the  thigh  and  leg  of  a little  girl  who 
received  a lacerated  wound  from  being  run  over  by  a loaded 
truck.  Extensive  sloughing  of  the  muscles  took  place,  con- 
traction of  the  leg  upon  the  thigh,  displacement  of  the  patella, 
and  atrophy  of  the  muscles.  The  bones  are  preserved  in  their 
natural  connection,  and  the  specimen  shows  an  extreme  con- 
traction of  the  joint,  the  outer  condyle  of  the  femur  being 
absorbed,  and  its  place  being  occupied  by  the  patella.  The 
limb  was  amputated  ten  years  after  the  accident. 

Dr.  Abel  L.  Peirson , of  Salem. 

251.  Ragged  exostoses  about  the  edge  of  the  patella;  similar  to 
what  is  so  often  seen  about  the  bodies  of  the  vertebra  and  the 
head  of  the  femur. 

252.  Transverse  fracture  of  the  patella,  the  fragments  being  sepa- 
rated about  two  thirds  of  an  inch.  A wet  specimen. 

Dr.  Winslow  Lewis. 

253.  Fracture  of  the  patella,  in  which  the  fragments  are  separated 

four  inches.  A dry  specimen.  Dr.  S.  D.  Townsend. 


DISEASED  BONES. 


59 


254.  Tibia  and  fibula  much  enlarged,  and  rough  on  the  surface 

from  numerous  osseous  granulations,  spines,  &c. ; bones  solid ; 
lower  extremities  anchylosed.  From  a man  about  sixty  years 
of  age.  Had  had  an  ulcer  on  lower  part  of  leg  for  about 
thirty  years.  Two  years  before  he  applied  for  advice  he  had 
a fever,  after  which  the  ulcer  increased,  so  that,  when  the  thigh 
was  amputated  by  Dr.  J.  C.  Warren,  it  involved  the  whole 
circumference  of  the  lower  third  of  the  leg;  had  excessive 
pain  about  the  outer  ancle,  to  explain  which  a nerve  of  con- 
siderable size  was  found  passing  between  one  of  the  rough, 
broad  exostoses ; the  ancle-joint  was  almost  immovable  from 
the  thickened,  condensed  state  of  the  cellular  membrane. 
The  patient  did  well.  Dr.  Charles  T.  Hildreth. 

255.  Bones  of  both  legs  of  a sailor.  The  tibiae  are  much  enlarged, 

heavy,  and  grooved  on  the  surface  like  worm-eaten  wood  ; one 
of  them  having  been  sawed  through  longitudinally,  the  en- 
largement is  seen  to  be  owing  in  a great  measure  to  a deposit 
upon  the  surface,  the  limits  between  the  old  and  the  new  bone 
being  in  some  places  well  marked.  The  fibulae  are  less  en- 
larged, but  rough  from  osseous  spines,  intersected  by  deep 
grooves.  Dr.  George  Parkman. 

256.  Tibia  and  fibula,  diseased  as  in  the  last  two  specimens,  though 
more  so,  and  especially  the  fibula,  the  bones  being  co-ossified 
from  below  upwards  to  where  they  are  sawed  across.  The 
limb  was  amputated  below  the  knee,  for  an  ulcer  on  the  leg, 
and  the  patient  did  well.  1838.  Dr.  Charles  H.  Stedman. 

257.  Tibia  and  fibula  of  the  right  leg ; the  patient  had  an  immense 

ulcer,  which  came  on  after  “ bilious  fever ; ” amputation  below 
the  knee  was  performed  by  Dr.  Stedman,  and  the  man  did  well. 
The  fibula,  to  a considerable  extent,  is  very  greatly  enlarged 
and  covered  with  rough  spines  and  inequalities.  Tibia  also 
enlarged  and  rough,  but  much  less  so  than  the  fibula ; where  it 
is  sawed  through  it  is  seen  that  much  of  the  enlargement  is 
owing  to  a deposit  of  new  bone  upon  the  surface  of  the  old. 
1838.  Dr.  Charles  H.  Stedman. 


258.  Tibia  and  fibula  of  the  left  side,  from  a case  of  old  ulcer ; 


60 


DISEASED  BONES. 


removed  after  death.  The  tibia  is  somewhat  enlarged,  the 
surface  rough,  and  the  whole  bone  curved  so  as  to  form  a 
remarkable  convexity  inwards  ; the  two  bones  are  anchylosed 
firmly  at  the  lower  extremity.  1838. 

Dr.  Charles  H.  Stedman. 

259.  Tibia  and  fibula  from  a case  of  old  ulcer  of  the  leg,  but  much 

less  diseased  than  in  the  above  cases ; removed  after  death. 
1838.  Dr.  Charles  H.  Stedman. 

260.  Bones  of  the  leg ; upper  third  removed,  perhaps  by  amputa- 
tion, the  history  of  the  case  being  unknown.  The  tibia  is  uni- 
formly and  greatly  enlarged,  heavy,  rough  on  the  surface,  and 
towards  the  lower  extremity  has  a worm-eaten  appearance ; 
line  of  periosteum  not  traceable  w7here  it  has  been  sawed 
across.  Fibula  very  little  affected.  1841. 

Dr.  George  C.  Shattuck , Jr. 

261.  Old  fracture  of  the  bones  of  the  right  leg.  The  tibia  is 
broken  midway,  and  the  fibula  somewhat  higher  up ; union 
strong,  but  very  irregular.  1838. 

Dr.  Charles  H.  Stedman. 

262.  Old  fracture  of  the  tibia  and  fibula  three  inches  above  the 
lower  extremity ; very  regular  union ; both  bones  have  been 
sawed  longitudinally.  From  a middle-aged  woman  ; the  acci- 
dent happened  about  twenty  years  before  death.  1S36. 

Dr.  M.  S.  Perry. 

263.  Very  oblique  fracture  of  the  lower  third  of  the  right  tibia, 
with  transverse  fracture  of  the  lower  extremity  of  the  fibula. 
From  a man,  fifty  years  of  age,  who  died  at  the  M'Lean  Asy- 
lum in  December,  1837,  about  four  years  after  the  accident. 

264.  Old  fracture  of  the  left  tibia  towards  the  lower  third,  and  of 
the  fibula  a little  higher  up.  Union  strong,  but  very  irregular  ; 
shortened  by  more  than  an  inch,  and  so  inclined  as  to  make 
an  angle  outwards,  the  upper  fragment  of  the  fibula  being 
anchylosed  with  the  lower  fragment  of  the  tibia.  1841. 

Dr.  George  C.  Shattuck,  Jr. 


DISEASED  BONES. 


61 


265.  Old  fracture  of  the  lower  third  of  the  tibia  and  upper  third  of 

the  fibula ; both  very  oblique.  Anchylosis  between  tibia  at 
seat  of  fracture  and  fibula.  The  upper  third  of  the  tibia  is 
enlarged,  as  from  inflammation  of  the  substance  of  the  bone. 
1841.  Dr.  George  C.  Sliattuck , Jr. 

266.  Old  oblique  fracture  of  both  bones  of  the  right  leg ; union 
strong  and  irregular,  with  extensive  anchylosis  ; surface  gene- 
rally rough.  From  the  dissecting  room ; the  subject  was  a 
middle-aged  man.  January,  1847.  Dr.  Winslow  Lewis. 

267.  Recent  compound  fracture  of  the  right  leg,  the  patient  having 
met  with  the  same  accident  in  the  same  limb  fourteen  years 
before.  The  old  fracture  of  the  tibia  was  just  below  the  mid- 
dle of  the  bone ; union  strong,  though  irregular ; immediately 
below  this,  but  not  involving  it,  is  the  recent  fracture,  the 
direction  being  transverse  as  seen  on  the  upper  fragment, 
though  the  lower  fragment  is  comminuted.  The  old  fracture 
of  the  fibula  was  towards  the  upper  third  ; the  union  is  strong 
though  very  irregular,  and  immediately  below,  though  not 
involving  it,  is  the  present  fracture ; the  same  bone  is  also 
broken  towards  its  lower  extremity.  No  experiment  could 
show  better  the  strength  of  an  united  fracture.  The  patient, 
an  Irish  laborer,  aged  forty-five,  entered  the  Massachusetts 
General  Hospital  August  22, 1838,  two  hours  after  the  accident, 
the  skin  and  muscles  of  the  right  leg  being  extensively  injured. 
On  the  following  day  amputation  was  advised,  but  to  this  he 
would  not  consent,  having,  as  he  said,  already  lived  through 
one  such  accident.  The  constitution,  however,  soon  began  to 
be  affected,  the  appearance  of  the  limb  was  very  bad,  and  on 
the  28th  it  was  amputated  above  the  knee ; but  the  patient 
continued  to  sink,  and  died  on  the  6th  of  September. 

268.  Compound  and  comminuted  fracture  of  the  leg.  The  patient, 
an  Irish  laborer,  aged  sixty-five,  of  intemperate  habits,  and  a 
broken  down  constitution,  entered  the  Massachusetts  General 
Hospital  August  22,  1838,  and  amputation  would  have  been 
performed  at  once  but  for  the  state  of  the  system.  He  was 
removed  to  the  Alms-house,  December  14th,  and  about  five  or 
six  weeks  afterwards  died.  Some  of  the  fragments  have 


62 


DISEASED  BONES. 


united  very  irregularly,  and  others  not  at  all ; there  is  also 
some  separation  of  the  old,  and  a considerable  deposit  of  new 
bone.  Dr.  Ezra  Palmer. 

269.  Old  and  strongly  united  fracture  of  both  bones  of  the  leg,  four 

inches  above  the  ancle-joint.  From  the  perfect  smoothness  of 
the  anterior  edge  of  the  bones,  and  general  inclination  for- 
wards of  the  lower  fragments,  contrasted  with  the  irregularity 
and  rather  abrupt  angle  observed  upon  the  posterior  face,  this 
appears  much  like  a case  of  partial  fracture ; yet  the  patient 
was  an  adult,  a celebrated  horse-jockey.  A narrow  slip  of 
bone,  half  an  inch  in  length,  projects  very  abruptly  from  the 
posterior  edge  of  the  fibula.  Dr.  George  Parkman. 

270.  The  lower  extremity  of  a Chicken,  the  tibia  being  twisted  so 
that  the  foot  points  directly  backwards ; the  result  of  external 
injury,  with  perhaps  a partial  fracture.  Dr.  Samuel  Cabot. 

271.  Compound  fracture  of  the  tibia  of  a Sand-piper.  Union 
entirely  by  new  bone,  and  very  irregular;  a portion  of  the 
upper  fragment,  two  lines  in  length,  protruded  externally,  and 
was  in  the  process  of  being  thrown  otf.  1838. 

Dr.  Henry  J.  Bigelow. 

272.  Fracture  of  the  upper  third  of  the  tibia  and  fibula  of  a Baboon. 

1836.  Dr.  Winslow  Lewis. 

273.  Upper  portion  of  the  tibia  and  fibula  of  both  sides,  from  a 
man  who  had  both  limbs  amputated  for  frozen  feet ; he  lived 
one  year  after  the  operation,  and  the  ends  of  the  bones  have 
become  rounded  and  perfectly  smooth. 

Dr.  S.  D.  Townsend. 

274.  Tibia  and  fibula,  fourteen  years  after  amputation  below  ‘the 

knee;  rounded  and  perfectly  smooth  as  the  above.  From  a 
man  aged  forty.  1838.  Dr.  A.  A.  Gould. 

275.  A third  specimen ; history  unknown.  1841. 

Dr.  George  C.  Shattuck , Jr. 


DISEASED  BONES. 


63 


276.  Disease  of  both  bones  of  the  leg  and  ancle-joint.  The  last 

three  inches  of  the  tibia  and  fibula  are  enlarged ; the  surface 
is  rough  and  porous,  the  structure  light  and  fragile,  and  within 
the  tibia  there  is  a mass  of  dead  cancellated  substance,  there 
being  two  very  well  defined  openings  from  the  internal  cavity, 
besides  a larger  one  which  may  be  in  part  accidental.  The 
two  bones  are  anchylosed  to  a small  extent.  The  astragalus  is 
partly  absorbed,  its  form  much  altered,  and  it  is  extensively 
anchylosed  with  the  tibia  and  os  calcis.  The  patient  was  a 
large,  healthy-looking  woman,  sixty-two  years  of  age,  and  had 
had  a swelling  about  the  ancle-joint  for  many  years,  with  much 
pain  and  discharge ; the  limb  was  amputated  below  the  knee 
by  Dr.  L.  about  eight  years  ago,  and  she  did  perfectly  well. 
1847.  Dr.  Winslow  Lewis. 

277.  Disease  of  the  tibia.  The  lower  portion  of  the  bone  is  en- 
larged, rough  on  the  surface,  and  veiy  light  from  interstitial 
absorption. 

278.  Tibia  and  fibula,  showing  caries  of  the  inner  malleolus ; also 
patches  of  new  deposit  in  several  places  upon  the  surface  of 
both  bones. 

279.  Sequestrum,  eight  inches  in  length,  from  the  tibia  of  a 
little  girl,  about  six  years  of  age,  the  disease  having  existed  for 
several  years;  an  operation  was  performed,  and  death  ensued 
within  twenty-four  hours,  apparently  from  exhaustion. 

Dr.  J.  H.  Lane. 

280.  Portion  of  tibia  affected  with  a venereal  node,  and  sawed  open 

longitudinally  to  show  the  condition  of  the  bone ; it  is  solid, 
compact  in  structure,  and  considerably  enlarged  ; rough  and 
fretted  on  the  surface  ; no  appearance  of  periosteal  deposit  on 
cut  surface ; cavity  somewhat  narrowed.  From  the  same 
subject  as  No.  96.  This  patient  had  suffered  much  from  pain 
in  the  limbs.  Dr.  A.  A.  Gould. 

281.  Venereal  node  on  the  right  tibia;  it  commences  just  above  the 

lower  extremity,  and  extends  upwards  about  five  inches  ; whole 
circumference  affected  except  the  front ; bone  enlarged,  and 
the  surface  rough.  1838.  Dr.  Charles  H.  Stedman. 


64 


DISEASED  BONES. 


282.  Venereal  node  on  the  inside  of  the  left  tibia,  towards  the 

lower  extremity.  1838.  Dr.  Charles  H.  Stedman. 

283.  Venereal  node  on  the  inside  and  front  of  the  left  tibia,  towards 

the  lower  third ; there  is  also  some  disease  higher  up.  The 
appearance  of  the  bone  is  about  the  same  in  these  last  three 
cases.  Dr.  Charles  H.  Stedman. 

284.  Tibia  of  an  adult  female,  showing  the  effect  of  a venereal 
ulcer  four  inches  above  the  ancle.  At  this  part  there  is  a well 
defined  and  very  considerable  thickening  of  the  bone  to  the 
extent  of  about  one  inch  and  a half ; the  surface  has  a coral- 
like roughness,  and  the  surrounding  bone  is  enlarged. 

285.  A small,  irregular  growth  of  bone  from  the  spine  of  the  tibia, 

connected  with  an  ulcer  which  was  regarded  as  venereal. 
From  a young  female,  who  died  at  the  Alms-house  of  typhoid 
fever.  1834.  Dr.  J.  W.  JWKean. 

286.  Fungous  growth  from  the  tibia.  The  patient,  a slave  driver, 
aged  thirty-eight,  from  the  south  of  Florida,  entered  the  Massa- 
chusetts General  Hospital  April  17th,  1838,  and  reported  as 
follows : — About  seventeen  years  ago  he  had  fever,  in  the 
course  of  which  boiling  water  was  poured  upon  his  legs  to 
produce  vesication ; extensive  ulceration  followed,  and  con- 
tinued till  last  summer,  when  the  left  leg  healed.  On  the  right 
leg  the  ulcer  has  remained  open ; two  years  ago  it  began  to 
assume  a fungous  appearance,  and  last  January,  being  very 
large,  it  was  removed,  and  the  tibia  was  .scraped,  but  it  has 
since  returned,  and  is  now  larger  than  ever,  very  painful, 
occasionally  bleeding,  and  exceedingly  offensive.  Has  had 
quotidian  yearly  since  first  attack  of  fever,  but  otherwise 
sufficiently  well  till  two  years  ago ; since  then  has  kept  his 
bed,  taken  laudanum  freely,  and  is  now  greatly  reduced,  and 
almost  bloodless  in  appearance.  Three  days  after  admission 
the  limb  was  removed  below  the  knee ; during  the  operation 
he  lost  much  blood,  and  two  weeks  afterwards  he  had  secondary 
haemorrhage,  for  which  the  femoral  artery  was  tied  ; his  gene- 
ral health,  however,  improved  very  much,  and  on  the  14th  of 
July  he  was  discharged  well,  though  the  stump  had  not  quite 
healed. 


DISEASED  BONES. 


65 


The  limb  having  been  very  fully  injected  with  size  and  ver- 
milion, the  fungous  growth  assumed  at  once  very  much  the 
appearance  that  it  had  before  the  operation,  of  a large  mass  of 
exuberant  granulations,  measuring  six  inches  in  length,  three 
or  four  in  width,  and  rising  abruptly  two  inches  or  more  above 
the  surrounding  surface,  which  was  quite  healthy.  A longitu- 
dinal incision  having  been  afterwards  made  through  the  centre 
of  the  diseased  mass,  and  extending  quite  through  the  limb, 
the  tumor  was  found  to  be  solid  throughout,  of  a whitish  color, 
consisting  of  a coarse  fibro-cellular  structure,  the  fibres  radia- 
ting from  an  opening  in  the  tibia  towards  the  surface  of  the 
tumor,  and  being  mixed  with  a more  opaque  and  softer  sub- 
stance ; no  encephaloid  substance  nor  effused  blood  ; the  bone 
and  periosteum  appeared  healthy,  except  for  the  opening,  which 
was  about  an  inch  in  extent.  One  half  of  the  limb  having  been 
put  immediately  in  alcohol,  the  above  appearances  are  well 
preserved. 

287.  A small  exostosis  from  the  inside  of  the  head  of  the  tibia. 

From  a middle-aged  man.  Dr.  J.  B.  S.  Jackson. 

288.  Fracture  of  the  fibula,  midway ; union  very  regular. 

289.  Exostosis  from  the  upper  portion  of  the  fibula.  It  is  about 
the  size  of  an  English  walnut,  rough  on  the  surface,  but  quite 
solid,  and  arises  by  a smooth  peduncle  an  inch  in  length  by 
one-third  of  an  inch  in  diameter.  Removed  by  Dr.  W.  from 
a man  at  the  State  Prison. 

Dr.  William  J.  Walker,  of  Charlestown. 

290.  Lower  half  of  the  fibula  greatly  diseased ; bone  enlarged, 
rough  and  earthy  on  the  surface,  and  very  light. 

291.  Disease  of  the  fibula.  The  lower  portion  of  the  bone  is 
enlarged  to  the  extent  of  four  inches,  and  has,  externally,  a 
coarsely  reticulated  appearance,  there  being  some  appearance 
of  a sequestrum  within ; otherwise  the  bone  is  quite  sound. 

292.  Tibia  and  fibula  firmly  anchylosed  to  the  astralagus,  the  tibia 
being  somewhat  enlarged.  1841. 

9 Dr.  George  C.  Shattuck,  Jr. 


66 


DISEASED  BONES. 


293.  Disease  of  the  ancle-joint  and  tibia,  from  a young  woman  who 
died  of  phthisis  at  the  Massachusetts  General  Hospital,  in 
November,  1837 ; nothing  known  as  to  its  history.  The  tibia, 
astragalus,  and  os  calcis  are  anchylosed.  The  shaft  of  the 
tibia  is  rather  slender  and  cylindrical,  uneven,  and  along  the 
inner  surface  quite  rough,  but  without  any  appearance  of 
necrosis ; head  of  fibula  anchyloted.  Bones  generally  rather 
light,  especially  towards  the  lower  extremity,  where  in  some 
parts  they  are  reduced  to  a mere  shell.  Before  dissection,  the 
head  of  the  tibia  seemed  to  project  very  much  inwards,  the 
skin  over  almost  the  whole  length  of  the  shaft  anteriorly  being 
bound  down,  dense,  and  shining,  with  here  and  there  a dried 
scab,  as  from  some  old  ulcer  or  sinus  ; no  suppuration  in  the 
soft  parts. 

294.  Ragged  exostosis  about  the  posterior  extremity  of  the  os  calcis ; 
similar  to  those  which  are  so  often  seen  about  the  vertebrae. 

295.  Anchylosis  of  the  astragalus  and  os  calcis,  from  an  adult. 

Dr.  Winslow  Lewis. 

296.  Anchylosis  of  the  astragalus,  os  calcis,  and  os  scaphoides, 
from  the  same  patient  as  the  last  specimen. 

Dr.  Winslow  Lewis. 

297.  Bones  of  the  foot  and  leg  prepared  in  connection,  and  show- 
ing the  changes  which  take  place  in  club-foot.  From  a 
healthy-looking  Irish  girl,  aged  twenty-five.  When  about  four 
years  old  she  was  run  over  by  a truck,  causing  a wound  on 
the  right  side  of  the  head.  For  two  days  she  was  senseless, 
but  afterwards  was  as  well  as  usual  till  about  three  weeks  after 
the  accident,  when  she  was  attacked  with  numbness  and  severe 
pain  in  the  left  foot  and  lower  half  of  the  leg,  also  in  the  sole 
of  the  right  foot.  The  numbness  in  the  right  foot  disappeared 
in  five  or  six  months ; on  the  left  side  it  continued  for  about 
two  years,  and  then  diminished.  No  pain  after  the  first  night. 
Was  obliged  to  use  crutches,  being  unable  to  bear  any  weight 
on  the  left  foot ; the  limb  was  much  smaller  and  shorter  than 
the  other,  and  on  account  of  the  great  incumbrance  the  patient 
desired  its  removal:  in  November,  1837,  she  entered  the 


DISEASED  BONES. 


67 


Massachusetts  General  Hospital,  and  amputation  was  performed 
below  the  knee.  The  foot  was  affected  as  in  case  of  varus,  and 
the  form  of  the  tarsal  bones  and  their  articular  surfaces  is  seen 
to  be  much  altered,  as  is  usual  in  that  deformity,  (Cruveilhier, 
Anat.  Path.  liv.  ii.) ; there  is  also  the  approximation  of  the  tibia 
and  fibula  noticed  by  Cruveilhier.  The  bones  of  the  foot  are 
exceedingly  light,  from  disuse. 

298.  Interstitial  atrophy,  from  disuse.  The  tarsal  bones  from  a 
case  of  diseased  knee-joint  (No.  243)  ; they  retain  their  full 
size,  but  are  as  light  as  cork.  Dr.  Woodbridge  Strong. 

299.  Exostosis  with  anchylosis  about  the  tarso-metatarsal  articula- 
tion of  a Horse. 

300.  Metatarsal  bone  of  a Deer,  fractured  midway,  and  regularly 

united.  1847.  Mr.  Samuel  L.  Bigelow. 

301.  Old,  ununited  fracture  of  the  metatarsal  bone  of  a Fowl,  near 

its  upper  extremity.  Dr.  S.  D.  Townsend. 

302.  Fracture  of  the  lower  part  of  the  metatarsal  bone  of  a Plover  ; 
the  union  is  sufficiently  regular,  though  not  yet  complete. 

Dr.  Samuel  Cabot. 

303.  Necrosis  of  the  os  calcis.  The  patient  was  a middle-aged 

man,  and  froze  both  of  his  feet  last  December,  whilst  in  a state 
of  deep  intoxication.  They  soon  sloughed  off  as  far  as  the 
tarsus,  and  for  some  time  past  the  greater  part  of  the  os  calcis 
on  both  sides  had  been  entirely  denuded  and  nearly  black. 
Dr.  W.  saw  this  patient  recently,  whilst  on  a visit  into  the 
country  in  regard  to  another  case  ; he  found  him  suffering 
severely  and  earnestly  desirous  of  immediate  relief.  The  os 
calcis  upon  the  right  side,  with  the  astragalus,  were  therefore 
removed ; and,  by  sawing  off  the  malleoli,  a sufficient  ffap  was 
obtained.  May  10th,  1847.  Dr.  J.  M.  Warren. 


(68) 


III.  SOFT  PARTS  ABOUT  THE  BONES. 


304.  Ligaments  of  the  shoulder-joint. 

305.  Ligaments  of  the  knee-joint. 

306.  Ossification  of  the  cartilages  of  the  ribs. 

Dr.  George  Parkman. 

307.  The  middle  finger  of  the  right  hand  torn  off  by  machinery, 
and  the  flexor  tendon  with  the  muscle  drawn  out ; a wet  speci- 
men. This  case  happened  more  than  thirty  years  ago,  in  the 
practice  of  the  late  Dr.  John  Jeffries.  The  patient,  who  is  still 
living,  was  a healthy,  middle-aged  man ; the  jagged  end  of  the 
bone  was  sawed  off,  and  for  the  first  three  days  there  was  some 
soreness  along  the  fore-arm,  but  without  any  swelling;  the 
wound,  however,  was  very  painful,  and  did  not  entirely  heal 
till  three  months  after  the  accident.  1843. 

Dr.  John  Jeffries. 

308.  Last  joint  of  the  index  finger  torn  off,  drawing  out  with  it  the 

flexor  tendon,  and  a small  piece  of  the  muscle ; a dried  speci- 
men. The  patient,  a healthy  lad,  seventeen  years  of  age,  got 
his  finger  caught  beneath  a heavy  piece  of  timber,  and  without 
waiting  for  assistance,  made  a sudden  and  strong  effort,  and 
tore  it  off  at  once.  Dr.  G.  finding  the  second  joint  in  a bad 
condition,  amputated  it,  and  the  lad  soon  recovered  without  an 
unfavorable  symptom  ; at  the  time  of  the  accident  the  pain 
was  by  no  means  so  great  as  would  have  been  expected,  and 
on  the  following  day  he  complained  only  of  soreness  along  the 
fore-arm.  Dr.  James  B.  Gregerson. 

309.  A bursa  over  the  patella,  two  inches  in  diameter,  and  about 
half  a line  in  thickness ; it  contained  a serous  fluid,  and  some 
small,  amorphous,  fibrinous  masses,  the  free  motion  of  which 
was  readily  felt  before  the  cyst  was  opened ; these  masses  are 
seen  at  the  bottom  of  the  jar.  From  a middle-aged  female. 

Dr.  J.  B.  S.  Jackson. 


SOFT  PARTS  ABOUT  THE  BONES. 


69 


310.  A dense,  fibro-cellular  tumor,  removed  by  Dr.  P.  from  over 
the  patella.  It  is  three  inches  in  length,  two  inches  and  a half 
in  width,  and  an  inch  and  three-fourths  in  thickness ; convex 
anteriorly,  but  fiat  posteriorly.  Not  far  from  the  centre  is  a 
coarse  cellular  tissue,  about  an  inch  in  extent,  into  which  the 
probe  enters  somewhat  freely,  and  on  the  skin  there  is  seen 
the  mark  of  an  issue.  This  tumor  probably  originated  in  a 
bursa ; Sir  B.  C.  Brodie  says,  in  his  Work  on  the  Joints, 
“ sometimes  the  membrane  of  the  bursa  becomes  thickened 
and  converted  into  a gristly  substance.  I have  seen  it  at  least 
half  an  inch  in  thickness,  with  a small  cellular  cavity  in  the 
centre  containing  synovia.” 

Dr.  Abel  L.  Peirson , of  Salem. 

311.  A bony  and  cartilaginous  mass  removed  from  the  knee-joint; 
operation  fatal  on  the  tenth  day.  The  size  of  the  specimen  is 
remarkable,  measuring,  now  that  it  is  dried,  sixteen  and  a half 
lines  in  length,  from  six  to  eight  and  a half  in  width,  and  in 
thickness  from  one  and  a half  to  two  lines.  It  consists  almost 
entirely  of  bone,  though  on  one  side,  which  is  strongly  concave, 
there  is  a layer  of  dried  cartilage,  which,  when  recent,  consti- 
tuted one-third  or  more  of  the  entire  mass ; the  other  side  is 
convex,  with  some  irregularities. 

The  patient,  a healthy-looking  young  man,  twenty  years  of 
age,  entered  the  Massachusetts  General  Hospital,  February 
21st,  1842.  Twelve  years  before,  he  fell  about  six  feet,  and 
struck  the  inside  of  the  left  patella  ; this  was  followed  by  much 
pain  and  swelling  of  the  joint,  which  continued  for  three  or 
four  weeks,  when  it  passed  off,  and  he  felt  no  further  inconve- 
nience for  six  months.  The  knee  then  began  to  swell,  and,  on 
examination,  a hard,  movable  body  was  felt  on  the  inside  of 
the  patella,  about  the  size  of  a bean,  and  without  tenderness. 
From  that  time  he  was  subject  to  frequent  attacks  of  pain  and 
swelling  of  the  knee ; pain  usually  not  severe,  the  principal 
trouble  being  from  the  slipping  of  the  foreign  body  between 
the  femur  and  the  tibia ; neither  this  body  nor  the  patella  could 
be  felt  when  the  knee  was  swollen.  On  the  5th  of  March,  an 
incision  was  made  over  the  outside  of  the  joint,  and  the  foreign 
body  was  removed,  having  been  found  perfectly  free ; inflam- 
mation supervened  on  the  evening  of  the  same  day,  followed 


70 


SOFT  PARTS  ABOUT  THE  BONES. 


by  the  most  severe  constitutional  symptoms,  and  the  patient 
died,  as  above  stated,  on  the  tenth  day. 

On  dissection,  extensive  abscesses  were  found  communica- 
ting with  the  knee-joint,  which  was  intensely  inflamed  ; also,  a 
large  abscess  beneath  the  psoas  muscle,  which  opened  into  the 
cavity  of  the  hip-joint.  There  was  also  other  disease  of  the 
knee-joint,  connected  with  the  attacks  of  inflammation  to  which 
the  patient  had  been  subject  previous  to  the  operation,  viz. : an 
extensive  destruction  of  the  cartilage  about  the  middle  of  the 
inner  condyle  of  the  femur,  and  an  increased  breadth  of  the 
corresponding  surface  of  the  tibia,  with  some  absorption  of 
cartilage  on  its  internal  edge,  and  exostosis  on  the  anterior. 
There  was,  however,  no  appearance  about  the  bones  to  show 
that  a piece  had  ever  been  knocked  off  by  external  violence. 

312.  Loose  bodies  from  a ganglion  above  the  wrist.  The  patient, 
Mrs.  M.,  aged  fifty-three,  entered  the  Massachusetts  General 
Hospital,  July  31,  1840.  The  disease  had  been  forming  for  a 
year  or  more,  and  for  the  last  ten  months  there  had  been  a 
swelling  in  the  palm  of  the  hand  ; the  fluctuation  beneath  the 
annular  ligament  was  distinct,  and  accompanied  with  a grating 
feel ; pain  not  constant,  but  lancinating,  and  frequently  shoot- 
ing up  the  arm.  On  the  day  of  her  admission  a free  incision 
was  made  by  Dr.  Townsend  into  the  sac  above  the  wrist,  and 
about  one  hundred  of  these  loose  bodies  were  discharged,  with 
a small  quantity  of  synovia.  They  are  perfectly  white,  smooth, 
polished,  on  an  average  about  the  size  of  apple-seeds,  some  of 
a veiy  regular,  oval  form,  but  many  of  them  quite  irregular; 
the  consistence  is  about  that  of  fibrine,  and  there  is  no  diffe- 
rence in  them  except  as  to  size  and  form.  The  opening  was 
enlarged  twice  subsequently  to  the  first  operation,  and  the 
patient  was  discharged,  doing  well,  on  the  12th  of  September. 

313.  A second  specimen,  similar  to  the  last.  The  patient  was  a 
sailor,  about  twenty-five  years  of  age,  and  the  disease  had 
existed  for  about  a year  ; there  was  a fluctuating  tumor  above 
and  below  the  annular  ligament,  and  the  loose  bodies  could  be 
felt  to  move  freely  within  it.  The  operation,  which  was  done 
about  a year  since,  was  not  followed  by  inflammation  of  the 
parts,  and  the  disease  has  now  (February,  1843)  returned. 


SOFT  PARTS  ABOUT  THE  BONES. 


71 


314.  Pendulous  excrescences  from  the  cavity  of  the  knee-joint. 
One  of  them  is  about  the  size  of  the  last  joint  of  the  little-fin- 
ger, and  the  other  about  two-thirds  as  large  ; they  appear  to 
consist  of  condensed  cellular  membrane,  with  some  fibrous 
structure ; the  form  is  regular,  the  edges  rounded  and  not 
fringed,  the  surface  polished,  and  they  are  now  of  a yellowish 
color,  looking  at  first  not  unlike  masses  of  fat,  though  when 
recent  they  are  reported  to  have  been  of  a bright  red  color. 
The  patient  was  a female,  twenty  years  of  age ; had  had  effu- 
sion into  the  bursa  over  the  patella  for  about  a year,  and,  as 
this  subsided,  the  disease  within  the  joint  was  discovered ; it  did 
not  cause  much  if  any  pain,  and  did  not  arrest  her  suddenly 
whilst  walking,  as  loose  cartilages  usually  do.  An  incision 
having  been  made  over  the  inner  condyle,  the  excrescences 
were  removed,  and  the  patient  did  well. 

Dr.  Abel  L.  Peirson , of  Salem. 

315.  A tumor,  removed  by  Dr.  L.  from  the  knee-joint.  It  appears 
to  consist  of  a condensed  cellular  substance,  and  is  about  one 
inch  and  three-fourths  in  length,  one  inch  in  width,  and  half  an 
inch  at  the  thickest  part ; it  is  flattened  on  one  side,  and  con- 
vex on  the  other,  the  edges  are  fringed,  as  in  Cruveilhier’s 
figure,  (Anat.  Path.  liv.  ix.  pi.  6,)  and  the  surface  is  somewhat 
rough,  the  edge  by  which  it  adhered  to  the  interior  of  the  joint 
being  of  a bright  red  color  when  recent.  The  patient  was  a 
lady,  twenty-four  years  of  age,  and  had  been  under  the  care 
of  an  empiric  for  slx  months  when  Dr.  L.  first  saw  her ; the 
principal  complaint  was  of  severe  pain  which  would  seize  her 
suddenly  whilst  walking,  and  compel  her  instantly  to  stop  ; the 
lameness,  left  by  the  pain,  would  subside  in  a few  days, 
and  then  she  would  be  quite  relieved.  Her  general  health 
was  good,  and  she  did  perfectly  well  after  the  operation. 

Dr.  Winslow  Leivis. 

316.  A second  tumor  removed  from  the  knee-joint  by  Dr.  L.  It  is 
one  inch  and  a third  in  length,  two-thirds  of  an  inch  in  width, 
and  one-third  of  an  inch  in  thickness ; the  form  is  oval,  both 
surfaces  are  flattened,  and  it  consists  apparently  of  condensed 
cellular  tissue.  The  patient  was  a female,  aged  twenty-seven, 
of  bad  constitution,  and  had  had  the  disease  for  six  or  seven 


72 


SOFT  PARTS  ABOUT  THE  BONES. 


years,  but  was  not  liable  to  be  arrested  by  such  severe  pain 
whilst  walking  as  was  the  last  patient.  Severe  inflammation  of 
the  limb  came  on  immediately  after  the  operation,  followed  by 
extensive  suppuration,  and  the  pati-'^t  died  on  the  thirty-first 
day.  December,  1836.  Dr.  Winslow  Lewis. 

317.  Disease  of  the  ancle-joint;  regarded  by  Dr.  T.  as  fungus 
hsematodes.  Preserved  entire  in  spirit,  having  never  been 
dissected.  “ The  patient  was  kicked  by  a horse  about  two 
years  before  the  amputation ; the  part  remained  indurated  ever 
after  until  a tumor  of  a bluish  color  formed,  which  was  opened 
and  discharged  blood ; a sinus,  about  an  inch  deep,  remained 
for  many  months,  from  which  blood  constantly  oozed,  until  a 
fungus  started  up  and  ulceration  ensued  with  a very  foetid  dis- 
charge, and  the  limb  was  amputated.” 

Dr.  S.  D.  Townsend. 

318.  Anchylosis  of  the  knee-joint;  not  bony.  From  a man,  aged 
forty-eight,  who  entered  the  Massachusetts  General  Hospital 
with  phthisis,  October  10th,  1838,  and  died  on  the  21st  of 
November.  Before  dissection  the  knee  seemed  but  little  if  at 
all  enlarged,  and,  by  using  great  force,  it  was  thought  that  a 
very  slight  motion  of  the  joint  was  perceived,  though  this  was 
quite  doubtful.  The  cavity  of  the  joint  was  entirely  obliterated, 
the  bones  being  closely  connected  by  a compact  cellular  tissue, 
which  has  been  cut  through ; nowdiere  any  union  by  bone ; no 
disease,  apparently,  in  the  integuments,  ligaments,  or  ends  of 
the  bones.  A wet  specimen,  and  preserved  in  an  open  jar,  so 
that  it  can  be  removed  and  examined.  On  his  admission  into 
the  Hospital,  the  patient  reported  that  two  years  previously, 
without  unusual  exertion  or  exposure,  he  felt  severe  pain  in 
the  left  knee,  which  on  the  following  morning  was  stiff,  and 
remained  so  ever  afterwards.  It  was  very  painful  for  the  first 
six  months,  so  that  he  was  unable  to  bear  the  least  weight  upon 
the  limb,  and  was  mostly  confined  to  his  bed. 


(73) 


IV.  HEART  AND  BLOOD-VESSELS. 


319.  Old  and  almost  universal  adhesion  of  the  pericardium.  From 
a little  girl,  four  years  of  age,  who  died  of  croup  supervening 
on  acute  pneumonia ; was  never  known  by  her  physician,  Dr. 
C.  T.  Hildreth,  nor  friends,  to  have  had  any  cardiac  symptoms, 
and  was  not  troubled  by  going  up  stairs  or  rising  ground.  1834. 

320.  A large,  thick,  ossific  plate  over  the  left  ventricle  of  the  heart, 
extending  from  the  base  downwards,  and  equal  to  about  one 
inch  and  a quarter  square ; a similar  plate  extends  nearly 
round  the  base,  but  much  narrower  than  the  above,  and  very 
irregular ; these  were  found  to  be  entirely  external  to  the 
organ,  except  at  one  point,  where  they  dipped  into  its  substance. 
There  were  almost  universal,  old  adhesions  of  the  pericardium, 
and  the  ossific  deposit  seemed  to  be  in  the  false  membrane. 
The  heart  was  of  about  the  usual  size ; mitral  valve  opaque, 
indurated,  and  somewhat  ossified,  the  passage  being  very  much 
contacted ; some  ossification  of  aorta  and  valves ; otherwise 
healthy.  The  whole  organ  has  been  dried,  to  show  the  ossifi- 
cation upon  the  external  surface. 

From  a man,  aged  sixty-four,  a patient  of  Dr.  A.  A.  Gould. 
Suffered  severely  from  rheumatism  thirty  years  before  death, 
from  which  time  he  had  more  or  less  dyspnoea  and  palpitation. 
Hemiplegia  of  right  side  ten  or  twelve  years  before  death, 
leaving  the  right  leg  exc'essively  cedematous.  Dr.  G.  was 
called  to  him  for  an  attack  of  severe  dyspnoea ; had  not  laid 
down  for  two  nights;  pulse  rapid  and  feeble,  but  regular ; was 
relieved  by  cathartics,  &c.,  and  in  the  course  of  the  month 
was  able  to  join  his  family,  the  pulse  meanwhile  becoming  very 
irregular.  Soon  began  to  fail  again,  and  died  in  the  course  of 
a few  weeks.  No  remarkable  sounds  ever  heard  in  region 
of  heart.  1839. 

321.  Foetal  heart  injected. 

322.  Interior  of  the  foetal  heart ; the  cavities  were  filled  with  tallow, 

10 


74 


HEART  AND  BLOOD-VESSELS. 


which  was  afterwards  melted  out,  and  the  organ  was  then  dried 
and  cut  open.  Dr.  J.  B.  S.  Jackson. 

323.  An  injected  preparation,  to  show  the  foetal  circulation.  The 

heart  and  blood-vessels  have  been  dissected  away  and  mounted, 
not  merely  the  organs  but  the  trunk  itself  having  been  removed ; 
the  form  of  the  left  auricle,  and  the  small  size  of  the  pulmo- 
nary veins,  which  are  not  usually  seen  in  these  preparations, 
are  thus  shown.  A small,  supernumerary  artery  arises  from 
the  arch  of  the  aorta.  Dr.  J.  B.  S.  Jackson. 

324.  An  injected  preparation  of  the  arteries  of  an  entire  subject ; a 
child  about  a year  and  a half  old. 

Dr.  Charles  T.  Jackson. 

325.  An  injected  preparation  of  the  arteries  of  the  upper  extremity. 

Dr.  Charles  T.  Jackson. 

326.  Casts  of  the  interior  of  the  right  auricle  and  left  ventricle  of 
an  adult  heart. 

327.  Casts,  in  wax,  of  the  interior  of  all  the  cavities  of  an  adult 

heart.  Dr.  George  C.  Shattuck , Jr. 

328.  Foramen  ovale  largely  open,  but  valvular.  A dry  prepara- 
tion. From  a lady,  a patient  of  Dr.  J.  M.  Whittemore,  of 
Brighton.  She  had  never  had  cardiac  symptoms,  but  enjoyed 
perfect  health,  and  died  of  acute  inflammation  of  the  articula- 
tions of  the  pelvis,  with  phlebitis,  after  confinement.  Such  an 
opening  as  existed  in  the  present  case  seems  to  be  not  at  all 
infrequent.  1837. 

329.  A very  large  and  direct  communication  between  the  auricles 
of  the  heart,  in  the  situation  of  the  foramen  ovale.  The  sep- 
tum only  has  been  preserved,  and  having  been  very  carefully 
dried,  it  shows  exactly  the  size  and  form  of  the  opening,  as 
represented  in  Fig.  1.  The  patient  was  a shoemaker,  and 
died  of  phthisis  at  the  age  of  twenty-five  years ; he  was  about 
six  feet  in  height,  moderately  fleshy,  and  in  infancy  was 
thought  to  be  very  robust,  but  began  to  be  less  so  when  he  was 


HEART  AND  BLOOD-VESSELS. 


75 


about  four  years  old.  The  heart  having  been  sent  to  the 
Society  in  a recent  state,  the  right  auricle  was  found  to  be 
very  much  dilated,  the  right  ventricle  dilated  and  hyper- 
trophied, with  some  opacity  and  thickening  of  the  lining  mem- 
brane and  tricuspid  valve,  the  pulmonary  artery  large,  the  left 
auricle  much  smaller  than  the  right,  the  mitral  valve  thick- 
ened and  opaque,  and  the  left  ventricle  small,  being  nowhere 
five  lines  in  thickness.  Dr.  Joseph  Osgood , of  Danvers. 

330.  A second  specimen  similar  to  the  last;  the  communication, 
however,  between  the  auricles  is  still  larger  than  in  that  case 
and  equally  direct.  The  septum  has  been  carefully  dried,  and 
the  size  and  form  of  the  opening,  as  it  appeared  in  the  recent 
state,  is  accurately  represented  in  Fig.  2;  in  each  case  the 
opening  is  seen  to  be  traversed  by  a narrow  slip  of  membrane. 

The  patient  was  a married  lady,  twenty-nine  years  of  age, 
and  died  in  this  city,  November  26th,  1840.  She  had  had 
palpitation  from  the  age  of  one  or  two  years,  and  when  she 
was  about  eight  years  old  this  increased,  but  was  attributed, 
with  a general  debility,  to  her  rapid  growth.  Her  health  after- 
wards improved,  but  she  suffered  much  from  violent  exercise, 
her  habits  being  active.  About  seven  years  before  her  death 
she  was  married,  and  soon  afterwards  removed  to  North  Caro- 
lina, where  she  enjoyed  good  health,  except  for  the  cardiac 
symptoms,  which  never  left  her.  In  July,  1839,  she  was  con- 
fined in  this  city,  and  was  attended  by  Dr.  George  B.  Doane, 
who  heard  nothing  of  any  affection  of  the  heart  till  about  three 
weeks  afterwards,  when  he  was  suddenly  called  on  account  of 
an  unusual  palpitation,  which,  however,  had  nearly  ceased 
when  he  arrived  ; on  examination,  the  organ  appeared  to  be 
greatly  enlarged,  but,  as  she  had  suffered  from  the  disease  for 
so  long  a time,  and  appeared  to  think  so  little  of  it,  nothing 
was  done,  and  in  a day  or  two  she  was  as  well  as  usual.  In 
October  she  returned  to  the  South,  and  met  with  a number  of 
disasters,  after  which  her  health  began  seriously  to  decline. 
In  July,  when  she  returned  to  this  city,  she  had  cough,  dys- 
pnoea, and  increased  trouble  from  going  up  stairs  or  rising 
ground ; the  pulse  regular  when  at  rest,  but  at  other  times 
irregular  and  intermitting,  though  not  greatly  so ; a bellows- 
sound  was  heard  by  Dr.  Shattuck,  Jr.,  who  attended  the  case 


76 


HEART  AND  BLOOD-VESSELS. 


for  a time ; ascites  and  oedema  had  existed  since  April,  and 
for  the  last  four  weeks  she  was  confined  to  the  house.  In  her 
figure,  this  patient  was  tall  and  well  formed, though  not  fleshy; 
complexion  pale  and  sallow,  but  her  friends  had  never  noticed  any 
lividity,  and  Dr.  D.  never  saw  any,  except  just  before  her  death. 

On  dissection,  about  two  pailfuls  of  water  were  found  in 
the  cavity  of  the  abdomen,  and  a gill  or  more  in  that  of  the 
pericardium.  Heart  very  much  enlarged;  right  auricle  and 
ventricle  hypertrophied  and  greatly  dilated ; pulmonary  artery 
much  dilated,  measuring  four  inches  and  a quarter  in  circum- 
ference ; left  auricle  rather  large,  but  very  much  less  so  than 
the  right ; mitral  valve  somewhat  thickened  and  opaque  ; left 
ventricle  and  aorta  healthy. 

331.  Foramen  ovale  open,  from  a female,  aged  seventy-five,  a 
patient  of  Dr.  John  Homans.  The  opening,  as  represented 
in  Fig.  3,  is  one-third  of  an  inch  in  diameter,  and  looks  as 
if  a piece  had  been  punched  directly  out.  The  patient  died 
from  encephaloid  disease  in  the  abdomen,  and  for  the  last  four 
years  had  had  dyspnoea  on  going  up  stairs,  with  inability  to  lie 
upon  the  left  side.  A portion  of  the  septum  between  the  auri- 
cles has  been  cut  out  and  dried,  the  heart  being  otherwise 
healthy.  March,  1845. 

332.  A small  interventricular  opening,  situated,  as  usual,  in  the  upper 
part  of  the  septum,  and  apparently  just  below  the  origin  of  the 
aorta  ; from  a boy,  eleven  years  of  age.  The  whole  heart  is 
preserved,  and  is  much  enlarged ; parietes  of  right  ventricle 
and  columnse  excessively  thickened ; left  ventricle  rather  thin 
than  otherwise  ; “ entrance  to  the  pulmonary  artery  indurated, 
and  small  as  compared  with  the  size  of  the  artery  ; opening  of 
the  foramen  ovale  about  one-fourth  of  an  inch  in  diameter ; 
ductus  arteriosus  open  sufficiently  to  admit  a small  probe.” 
This  patient  was  healthy  at  birth,  and  for  the  first  ten  days, 
when  he  took  cold,  became  emaciated,  and  remained  so  during 
the  first  year.  He  afterwards  became  corpulent,  and  con- 
tinued so  till  his  death ; extremities  comparatively  small ; suf- 
fered much  dyspnoea  and  lividity  on  motion,  was  much  affected 
by  cold  or  heat,  and  when  he  cut  himself,  the  blood  was 
observed  to  look  like  molasses.  As  he  grew  older  his  general 


HEART  AND  BLOOD-VESSELS. 


77 


health  improved.  The  night  before  his  death  he  went  to  bed 
as  well  as  usual,  but  there  soon  came  on  vomiting,  followed  by- 
insensibility,  with  symptoms  of  apoplexy,  and  in  three  hours  he 
died.  On  examination  § ij.  or  §iij.  of  blood  were  found  extra- 
vasated  in  the  head,  and  all  the  ventricles  were  filled  with 
coagula,  particularly  the  fourth.  This  case  was  published  in 
the  New  England  Medical  Journal  for  1816,  by 

Dr.  Robert  Thaxter , of  Dorchester. 

333.  Interventricular  opening,  from  a male  infant,  aged  twenty-one 
months,  a patient  of  Dr.  J.  Bigelow.  Dr.  B.  had  always 
noticed  a tumultuous  action  of  the  heart,  and,  whenever  exam- 
ined during  the  last  year,  a loud  bellows-sound ; some  dys- 
pnoea ; color  generally  florid ; moderately  fleshy ; died  of 
extensive,  acute  meningitis,  not  tuberculous.  Heart  enlarged 
and  remarkably  rounded ; right  ventricle  much  thickened ; 
opening  in  the  septum  just  below  the  aortal  valves  direct, 
rounded,  and  large  enough  to  admit  the  tip  of  the  little  finger, 
the  edge  towards  the  septum  being  thick  and  smooth.  The 
pulmonary  artery  is  small,  rather  thick,  and  has  only  two 
valves,  which  are  thick  and  rigid ; for  about  half  an  inch  before 
the  origin  of  this  vessel  the  cavity  of  the  ventricle  is  contracted, 
and  is  in  part  lined  by  a dense,  white  tissue,  which  extends 
towards  the  interventricular  opening  and  the  aortal  valves, 
giving  it  somewhat  of  a cicatrized  appearance.  The  heart  and 
vessels  were  otherwise  healthy,  and  in  the  preparation  the 
valves  and  greater  part  of  the  ventricles  have  been  cut  away. 
1840. 

334.  Interventricular  opening,  from  a lady  aged  twenty-three. 
From  birth  there  had  always  been  something  peculiar  about 
the  heart ; the  nurse  noticed  an  unusual  throbbing  within  the 
first  month ; action  violent  and  irregular  in  infancy,  and  con- 
tinued so  as  long  as  she  lived,  being  much  increased  when  she 
was  slightly  indisposed,  the  heart  at  such  times  stopping 
oftener  and  longer,  as  she  expressed  herself ; throbbing  also 
much  more  violent  when  in  bed.  By  her  friends  this  affection 
was  regarded  as  nervous,  as  her  general  appearance  was  that 
of  perfect  health;  complexion  very  fair,  and  usually  florid, 
but  with  some  lividity  when  excited.  She  was  married  about 


78 


HEART  AND  BLOOD-VESSELS. 


a year  before  her  death,  and  bore  one  child,  without  any 
marked  increase  of  the  cardiac  affection.  On  the  morning  of 
the  sixth  day  after  her  confinement  active  haemoptysis  came 
on ; in  the  evening  it  returned,  and  on  the  following  morning, 
she  died. 

On  dissection,  the  heart  was  found  much  enlarged,  weighing 
about  twenty-two  ounces,  (avoirdupois) ; quite  firm ; apex 
rounded.  Auricles  rather  large  ; foramen  ovale  largely  open, 
but  valvular.  Right  ventricle  much  dilated  and  hypertrophied, 
being  nearly  seven  inches  in  length  on  the  outside ; parietes 
six  lines  at  the  thickest  part,  and  the  column®  in  proportion. 
Opening  in  the  septum,  just  below  the  aortal  valves,  about 
three-fourths  of  an  inch  in  diameter.  The  pulmonary  artery 
arose  from  a regular  prolongation  from  the  right  ventricle, 
seven  or  eight  lines  in  diameter  and  four  in  extent ; at  the 
origin  of  this  prolongation  was  some  soft,  cellular  tissue,  and 
somewhat  higher  up  were  three  little  ridges  of  whitish,  con- 
densed, cellular  membrane,  of  a semilunar  form,  the  convexity 
being  upwards  towards  the  pulmonary  artery,  and  appearing 
altogether  as  if  they  might  be  the  valves  misplaced  and  atro- 
phied ; two  of  them  are  on  one  side  of  the  vessel,  and  the  third, 
which  is  most  distinctly  seen  in  the  preparation,  is  by  itself 
upon  the  opposite  side.  At  the  origin  of  the  pulmonary  artery 
from  this  prolongation,  was  a sacculated  appearance,  as  if  there 
had  been  an  attempt  to  form  valves  where  they  were  most 
needed ; at  this  last  part  the  vessel  was  two  inches  and  seven- 
eighths  in  circumference  ; seven  lines  higher  up,  where  there 
was  a marked  constriction,  it  measured  one  inch  and  a half, 
and  about  half  way  to  the  bifurcation  it  increased  again  to 
two  inches  and  two-thirds.  The  ductus  arteriosus  was  one 
and  a half  lines  in  diameter,  where  it  was  cut  across,  but  the 
connection  with  the  aorta  was  not  preserved,  when  the  heart 
was  removed.  Left  ventricle  dilated  and  hypertrophied ; 
length  six  inches,  and  maximum  thickness  eight  lines.  In  the 
preparation,  all  the  points  above  described  are  distinctly 
shown.  1838.  Dr.  J.  Stimson,  of  Dedham. 

335.  Septum  between  the  ventricles  entirely  wanting : from  a young 
man,  aged  twenty-one ; he  was  of  medium  size  as  to  height 
and  flesh;  face  and  nails  always  very  blue,  and  he  was  very 


HEART  AND  BLOOD-VESSELS. 


79 


sensitive  to  cold ; dyspnoea  and  palpitation  on  quick  motion,  yet 
he  was  able  to  go  about,  and  was  employed  to  go  of  errands 
at  the  Salem  Alms-house,  where  he  died  of  phthisis,  the  dura- 
tion of  his  pulmonary  disease  being  about  one  year;  was  out 
of  doors  until  a short  time  before  his  death.  The  organ  had 
been  in  spirit  for  some  time  when  it  was  sent  to  the  Society, 
but  appears  to  have  been  small.  Right  ventricle  thicker,  and 
the  left  thinner  than  natural,  and  without  the  slightest  trace  of 
a septum  between  the  two.  Mitral  and  tricuspid  valves  suffi- 
ciently developed ; the  last  has  been  cut  away.  Pulmonary 
artery  small;  it  arises  directly  from  the  ventricle,  and  has  but 
two  valves,  which  are  best  seen  on  the  back  of  the  preparation. 
The  aorta  is  of  proper  size,  and  has  three  valves;  it  arises 
from  a large  and  well  marked  prolongation  from  the  common 
ventricle,  and  which  seems  to  belong  as  much,  if  not  more,  to 
the  right  side  of  the  heart  than  to  the  left.  1838. 

Dr.  Benjamin  Cox , of  Salem. 

336.  Interventricular  opening,  the  pulmonary  artery  and  aorta 
arising  from  the  right  ventricle.  From  a young  Spaniard, 
aged  eleven  years ; had  had  cardiac  symptoms  from  infancy, 
and  would  sometimes  throw  himself  on  the  floor  to  get  relief ; 
was  well  nourished.  The  heart  was  enlarged,  firm,  and 
rounded.  Right  auricle  somewhat  dilated  and  hypertrophied; 
foramen  ovale  open  to  about  three  or  four  lines,  and  scarcely 
valvular.  Tricuspid  valve  a little  opaque  and  thickened.  Left 
auricle  well,  except  for  thickening  and  opacity  of  lining  mem- 
brane. Mitral  valve  well.  Cavity  of  left  ventricle  rather 
small ; parietes  thin,  measuring  nowhere  more  than  four  lines. 
Opening  at  the  upper  part  of  the  septum  between  the  ven- 
tricles two-thirds  of  an  inch  in  diameter.  Cavity  of  right 
ventricle  not  dilated ; parietes  from  three  to  four  lines  in  thick- 
ness on  an  average,  and  eight  at  the  thickest  part.  The  aorta 
and  pulmonary  artery  arise,  side  by  side,  directly  from  the 
cavity  of  the  right  ventricle ; the  first  is  one  inch  and  ten  lines 
in  circumference  at  the  valves,  and  the  second  two  inches  and 
a half ; a few  opaque,  whitish  spots  in  both,  above  the  valves, 
but  otherwise  not  remarkable;  ductus  arteriosus  closed.  1837. 

Dr.  J.  Bigelow. 


80 


HEART  AND  BLOOD-VESSELS. 


337.  A four-valved  pulmonary  artery ; from  an  adult  subject.  The 
valves  are  of  about  equal  size,  but  somewhat  reticulated. 

Dr.  Henry  1.  Bowditch. 

338.  A second  specimen,  one  of  the  valves  being  quite  small.  A 

dry  preparation.  1847.  Dr.  J.  B.  S.  Jackson. 

339.  Pulmonary  artery  arising  from  the  aorta ; the  heart  and  vessels 
are  preserved.  From  a child,  aged  five  months,  a patient  of 
Dr.  George  Hayward.  It  had  always  been  feeble,  and  the  chief, 
and  often  an  urgent  symptom,  had  been  dyspnoea;  the  impulse 
of  the  heart  was  increased,  there  was  no  marked  lividity,  and 
it  died  rather  suddenly,  September  11th,  1842.  The  heart 
was  very  much  enlarged,  especially  on  the  left  side ; maximum 
thickness  of  right  ventricle  three  lines  and  a half,  and  of  the 
left  four  lines.  All  of  the  valves  appeared  thickened,  and 
firm,  the  mitral  and  tricuspid  being  very  narrow.  Interven- 
tricular opening  sufficiently  large  to  admit  the  end  of  the  little 
finger.  The  aorta  at  its  origin  was  quite  large,  and  soon  gave 
off  two  pulmonary  branches,  close  together,  and  of  full  size ; 
it  also  continued  rather  large  to  the  arch,  where  it  gave  off  the 
left  vertebral,  besides  the  usual  branches. 

340.  The  heart  of  an  “ acephalous  foetus,”  which  was  sent  to  the 
Society  by  Dr.  Josiah  Noyes,  of  Needham.  The  aorta  is 
impervious  at  its  origin,  and  the  ascending  portion  is  no  larger 
than  the  innominata.  The  pulmonary  artery  and  its  branches, 
and  the  vessels  at  the  arch  of  the  aorta  are  of  full  size.  The 
left  auricle  is  not  much  if  at  all  smaller  than  usual,  but  the 
left  ventricle  would  hardly  contain  two  drops  of  fluid ; there 
are  traces,  however,  of  the  mitral  valve.  The  right  auricle  is 
not  remarkable,  but  the  cavity  of  the  ventricle  is  as  large  as 
that  of  both  together  usually  would  be.  1842. 

341.  The  heart  of  an  “ acephalous  fcetus,”  which  was  sent  to  the 
Society  by  Dr.  Milton  Fuller,  of  Medford.  The  pulmonary 
artery  is  impervious  at  its  origin ; the  common  trunk,  as  it 
is  usually  called,  is  not  more  than  a line  in  diameter,  and  the 
pulmonary  branches,  which  are  quite  small,  arise,  with  this 
trunk,  almost  directly  from  the  aorta,  there  being  no  proper 


HEART  AND  BLOOD-VESSELS. 


81 


ductus  arteriosus.  The  two  ventricles  are  sufficiently  devel- 
oped, and  there  is  a free  communication  between  them,  the 
aorta  arising  from  the  right  rather  than  from  the  left.  In  the 
preparation,  the  lungs  are  preserved  in  connection  with  the 
heart.  1845. 

342.  The  heart  of  a new-born  child,  showing  an  impervious  condi- 
tion of  the  pulmonary  artery.  The  trunk  of  this  vessel  is 
small,  but  the  branches  are  about  as  large  as  usual,  and  the 
ductus  arteriosus  has  begun  to  close.  The  cavity  of  the  right 
ventricle  is  exceedingly  small,  whilst  that  of  the  left,  from  its 
great  size,  is  equal  to  the  two  in  the  normal  state,  there  being 
no  communication  between  them ; it  differs  then  materially 
from  the  last  specimen,  and  is  analogous  to  the  one  preceding. 
The  right  ventricle,  however,  does  not  terminate  at  once,  as 
the  left  does  in  No.  340,  but  sends  off  a prolongation  which 
becomes  gradually  smaller,  and  winds  round  behind  the  pulmo- 
nary artery,  so  as  at  last  to  appear  in  front  between  this  vessel 
and  the  aorta ; there  it  was  accidentally  cut  off,  being  only 
large  enough  to  admit  a very  small  blunt  pin.  In  the  auricles 
nothing  unusual  was  observed,  except  for  an  absence  of  the 
Eustachian  valve  ; tricuspid  valve  distinct,  though  very  imper- 
fectly developed ; aorta  of  about  the  usual  size,  and  not  re- 
markable, except  for  a supernumerary  artery  between  the  left 
carotid  and  subclavian. 

This  case  occurred  in  the  practice  of  Dr.  Enoch  Hale.  The 
subject  was  a large  and  finely  developed  male  child  ; born  at 
the  full  period,  and  lived  about  twenty-nine  hours ; the  color 
of  the  face  was  quite  dark,  and  for  several  hours  before  death 
it  kept  up  a weak,  plaintive,  moaning  sound.  1841. 

343.  Ductus  arteriosus  open;  from  a male,  twin  child,  aged  twenty 
months,  a patient  of  Dr.  G.  H.  Lodge.  When  two  or  three 
days  old  it  was  observed  to  breathe  very  rapidly,  and  the  respi- 
rations went  on  increasing  till  about  the  age  of  six  months, 
when  the  number  amounted  to  fifty  or  sixty  in  a minute,  and 
so  continued  ever  afterwards,  being  the  most  prominent  symp- 
tom in  the  case  ; the  breathing  was  laborious  during  sleep,  but 
there  was  no  apparent  dyspnoea  when  awake.  General  ap- 
pearance delicate ; skin  very  clear,  but  never  in  the  slightest 

11 


82 


HEART  AND  BLOOD-VESSELS. 


degree  livid  ; pulse  regular.  The  affection  of  the  heart  was 
never  suspected,  and  it  died  after  an  illness  of  three  days, 
apparently  from  a slight  pulmonary  affection.  On  dissection, 
the  heart  was  found  enlarged,  firm,  rounded,  and  full  of  coag- 
ula.  Right  ventricle  hypertrophied.  The  pulmonary  artery 
was  large,  and  the  ductus  arteriosus  formed  a direct,  regular, 
rounded  opening  into  the  aorta,  one  line  in  diameter.  When 
dissected  in  situ,  the  pulmonaiy  artery  appeared  more  like  the 
origin  of  the  descending  aorta  than  the  aorta  itself.  Left  auri- 
cle dilated  and  hypertrophied;  foramen  ovale  closed.  Left 
ventricle  hypertrophied,  but  not  dilated,  the  maximum  thick- 
ness being  six  lines.  Organ  otherwise  healthy.  The  aorta 
was  rather  small  at  its  origin,  and  still  more  so  beyond  the 
vessels  at  the  arch ; at  the  entrance  of  the  ductus  arteriosus  it 
appeared  externally  contracted,  and  internally  there  was  a 
little  ridge  as  if  it  had  been  girt  at  that  part ; immediately 
afterwards  the  vessel  became  again  considerably  enlarged.  In 
the  preparation  the  pulmonaiy  artery  and  the  aorta  only  are 
preserved.  1838. 

344.  Supernumerary  artery,  about  the  size  of  the  vertebral,  arising 
from  the  arch  of  the  aorta  between  the  left  carotid  and  sub- 
clavian. An  injected  preparation. 

345.  A preparation,  showing  the  right  subclavian  artery  arising 
from  the  aorta  beyond  the  left  subclavian,  and  passing  behind 
the  oesophagus.  The  arteries  and  the  oesophagus  are  injected, 
and  are  colored,  the  first  red  and  the  last  blue ; the  trachea  is 
also  preserved,  and  is  colored  white.  From  a child.  1841. 

Dr.  J.  B.  S.  Jackson. 

346.  Wound  of  the  right  ventricle  of  the  heart;  it  is  an  inch 

and  a half  in  length,  and  to  the  extent  of  half  an  inch,  has 
penetrated  quite  through  into  the  cavity.  The  patient  was 
stabbed  in  the  side  with  a penknife,  and  died  in  about  fifteen 
minutes.  Mr.  Thomas  Restieaux. 

347.  Disease  of  the  mitral  valve.  From  a man,  aged  thirty-two,  a 
patient  of  Dr.  A.  A.  Gould ; had  been  subject  to  rheumatism 
for  some  years,  with  lividity  of  surface.  Dr.  G.  was  called  to 


HEART  AND  BLOOD-VESSELS. 


83 


him  in  the  night,  and  found  him  laboring  under  very  urgent 
dyspnoea ; the  whole  surface  was  livid ; pulse  not  less  than 
180;  impulse  of  heart  very  violent ; thirst  urgent.  Had  been 
at  work  on  the  day  before,  which  was  very  cold,  and  the 
attack  came  on  as  he  was  returning  home.  He  was  bled 
without  any  effect ; immediately  after  the  operation  of  an 
enema,  however,  he  felt  great  relief,  and  this  continued,  but  he 
sank,  and  died  on  the  following  day.  On  dissection,  there 
were  found  universal,  old  adhesions  of  the  pericardium.  Heart 
much  enlarged,  and  distended  with  blood.  Right  auricle  and 
ventricle  dilated  and  hypertrophied,  with  some  disease  of  the 
tricuspid  valve.  Pulmonary  artery  dilated.  Lining  membrane 
of  left  auricle  opaque,  dead  white,  and  much  thickened. 
Mitral  valve  opaque,  thickened,  indurated,  and  somewhat  ossi- 
fied ; passage  so  much  contracted  as  only  to  admit  the  tip  of 
the  little  finger  ; chord®  tendinese  much  thickened,  dense,  and 
opaque.  Left  ventricle  somewhat  thickened  and  dilated. 
Aorta  healthy;  valves  united  at  their  edges,  opaque,  whitish, 
much  thickened,  and  indurated,  though  not  ossified.  In  the 
preparation  the  mitral  valve  has  not  been  cut  through,  and  the 
disease  is  very  distinctly  shown,  the  rest  of  the  organ  having 
been  cut  away. 

348.  A dried  preparation,  showing  an  extensive  ossification  of  the 
mitral  valve,  column®  carnese,  aortal  valves,  and  coronary  arte- 
ries. There  were  old  adhesions  of  the  pericardium,  and  great 
hypertrophy  of  the  left  ventricle.  From  a female,  aged  sixty- 
four,  a patient  of  Dr.  John  Homans ; subject  to  rheumatism  ; 
cardiac  symptoms  for  about  two  years  ; greatly  troubled  by  an 
irregular  agitation  about  the  heart  rather  than  proper  palpita- 
tion ; dyspnoea,  much  increased  by  rising  ground ; faintness  at 
epigastrium  was  one  of  the  chief  symptoms.  Over  the  heart 
a bellows-sound  was  heard,  and  to  a considerable  extent  an 
irregular,  tremulous  motion  instead  of  the  regular  action,  and 
the  same  was  communicated  to  the  radial  artery.  Three 
weeks  before  death,  after  a long  walk  in  the  rain,  there  came 
on  acute  pneumonia,  of  which  she  died. 

349.  A dried  preparation,  showing  ossification  of  the  mitral  and 
aortal  valves,  and  of  the  coronary  arteries.  The  left  ventricle 


84 


HEART  AND  BLOOD-VESSELS. 


was  thickened,  and  somewhat  dilated;  lining  membrane  of  left 
auricle  thickened  and  opaque.  From  a female,  aged  sixty-six, 
a patient  of  Dr.  Edward  J.  Davenport;  chronic  catarrh  for  ten 
years ; much  loose  cough,  with  wheezing ; dyspncea,  increased 
by  exercise  and  especially  by  rising  ground ; pulse  intermit- 
tent and  very  irregular ; ascites  and  anasarca  for  some  months 
before  death;  died  of  apoplexy.  A large  clot  of  blood  was 
found  in  the  left  anterior  lobe  of  the  brain,  and  the  arteries  at 
the  base  were  ossified. 

350.  The  tricuspid  valve  dissected  out  and  dried,  showing  an  ossific 
deposit,  about  the  size  of  a small  pepper-corn,  in  the  free  edge 
of  the  valve,  and  two  others,  about  as  large,  just  where  the 
chordse  tendinese  are  inserted  into  the  ventricle.  The  valve 
was  otherwise  quite  healthy,  and  the  heart  generally  was  suffi- 
ciently so.  The  patient,  a negress,  aged  fifty-eight,  died  at 
the  Alms-house,  January  12th,  1845,  of  disease  of  the  lungs 
and  pleura,  but  without  cardiac  symptoms,  so  far  as  was  known. 

351.  Vegetations  on  the  aortal  valves. 

Dr.  Charles  H.  Stedman. 

352.  Extreme  ossification  of  the  aortal  valves,  from  a patient  of 
Dr.  J.  Bigelow.  Two  of  the  valves  are  intimately  connected, 
if  there  were  ever  more  than  two,  and  they  form,  altogether,  a 
narrow,  semilunar  slip,  which,  in  the  recent  state,  would  hardly 
allow  a probe  to  pass,  the  specimen  resembling  very  much  one 
that  is  figured  by  Dr.  Baillie  in  his  work  on  Morbid  Anatomy, 
(PI.  2,  fig.  3.)  A dry  preparation,  the  valves  only  being  pre- 
served. A blackish,  carious  cavity,  one  or  two  lines  in  diame- 
ter, is  also  shown  in  the  ossific  mass,  the  same  having  been 
observed  in  an  ossified  mitral  valve  recently  presented  to  the 
Society.  The  left  ventricle  of  the  heart  was  hypertrophied, 
with  dilatation  of  the  ascending  aorta,  and  some  disease  of  the 
tricuspid  and  mitral  valves. 

The  patient  was  a gentleman,  seventy-six  years  of  age,  who 
died  of  acute  pleuro-pneumonia.  He  had  been  remarkably 
regular  in  all  his  habits,  and  his  family  knew  nothing  of  car- 
diac disease,  though  for  about  two  years  he  had  had  palpitation 
and  dyspncea,  which  were  increased  by  exercise.  During  his 


HEART  AND  BLOOD-VESSELS. 


85 


last  sickness  Dr.  B.  found  the  pulse  exceedingly  irregular,  and 
a loud  bellows-sound  in  place  of  the  first  sound  of  the  heart. 
1843. 

353.  Left  ventricle  much  dilated,  and  the  parietes  rather  thin. 

Right  ventricle  not  affected.  From  a little  girl,  about  six  years 
old,  a patient  of  Dr.  A.  A.  Gould. 

354.  Immense  dilatation  of  the  left  ventricle,  the  parietes  being  of 
about  the  usual  thickness ; the  right  ventricle  appears  exceed- 
ingly small  by  its  side ; aorta  much  diseased,  but  nowhere 
contracted.  The  whole  organ  is  preserved.  From  a man, 
aged  forty-four,  a patient  of  Dr.  Charles  T.  Hildreth.  Cardiac 
symptoms  for  five  years ; pain  and  oppression  in  region  of  the 
heart,  with  much  palpitation  and  dyspnoea ; no  lividity ; pulse 
not  remarkable.  There  was  extensive  dulness  on  percussion 
in  cardiac  region;  impulse  of  heart  and  sound  very  much 
increased,  this  last  being  sometimes  heard  at  a distance  from 
the  chest.  Died  in  a fit  of  epilepsy,  to  which  disease  he  had 
been  subject  for  the  last  ten  years,  nothing  unusual  being 
found  in  the  head  but  extreme  congestion. 

355.  Aneurism  of  the  heart.  The  patient  was  a bookseller  in  this 
city,  aged  sixty-seven,  tall,  thin,  pale,  regular  in  his  habits,  and 
of  excellent  character.  About  ten  years  before  his  death  he 
had  an  attack  of  what  was  regarded  as  pericarditis,  for  which 
he  was  bled,  and  from  that  time  he  had  suffered  from  dyspnoea 
on  exertion.  On  the  5th  of  December,  1843,  he  sent  for  Dr. 
John  Ware ; the  dyspnoea  was  considerable,  with  palpitation 
on  exercise,  so  that  he  could  not  walk  to  his  store,  which  was 
at  the  distance  of  a quarter  of  a mile  ; ancles  oedematous,  as 
they  had  occasionally  been  during  the  past  year ; diy,  tickling 
cough  for  a week  or  more.  Impulse  of  heart  considerable, 
and  in  lower  cardiac  region  towards  sternum  the  stroke  was 
impulsive  and  tremulous,  like  that  of  a steam  engine  ; first 
sound  muffled,  second  distinct.  Pulse  72  to  80,  not  thumping, 
but  rather  tremulous.  Could  lie  down  as  usual,  and  upon 
either  side,  but  could  not  go  up  stairs  without  suffering.  Counte- 
nance changed,  but  thought  he  had  not  lost  flesh.  From  the 
above  date  till  his  death,  which  occurred  on  the  15th  of  the 


86 


HEART  AND  BLOOD-VESSELS. 


same  month,  after  a paroxysm  of  six  hours  duration,  he  suf- 
fered much  from  dyspnoea  and  distress  in  the  cardiac  region  ; 
his  countenance  was  very  pale,  and  he  looked  and  expressed 
himself  as  feeling  perfectly  exhausted ; rode  once  to  his  store, 
though  he  could  move  but  a few  steps  without  dyspnoea ; pulse 
about  96,  and  always  thrilling. 

On  dissection,  there  were  found  two  large  white  patches 
upon  the  ventricles  of  the  heart,  which  were  regarded  as  the 
effect  of  the  pericarditis  above  alluded  to.  The  organ  itself 
was  of  about  the  usual  size,  but  at  the  apex  looked  rounded, 
felt  stiff,  and  crackled  under  pressure,  like  an  ossified  aorta ; 
there  was  no  distinct  external  tumor,  however.  The  left  ven- 
tricle was  then  cut  open,  and  was  found  to  be  dilated  at  its 
apex  into  a regular,  rounded,  well-defined  cavity,  about  the  size 
of  a pullet’s  egg,  the  parietes  of  this  cavity  being  thin,  opaque, 
and  degenerated  in  structure,  precisely  like  an  ossified  and 
otherwise  diseased  artery.  The  blood  in  the  cavities  of  the 
heart  was  not  remarkable,  and  the  organ  otherwise  was  suffi- 
ciently well.  Some  ossification  at  arch  of  aorta,  some  serous 
effusion  in  lungs  and  in  pleural  cavities,  and  some  disease  of 
the  liver  with  calculi  in  the  gall-bladder  were  found,  the  other 
organs  being  healthy. 

In  the  preparation  the  whole  heart  has  been  preserved,  the 
left  ventricle  being  distended  so  as  to  show  the  interior  of  the 
aneurismal  cavity. 

356.  Tubercles  in  the  right  ventricle  of  the  heart.  Two  white, 
opaque,  curdy  masses,  well-defined,  and  quite  prominent,  one 
upon  the  external,  and  the  other  on  the  internal  surface ; the 
first  is  four  lines  in  diameter,  and  the  other  about  two-thirds  as 
large.  Organ  otherwise  healthy.  Tubercles  were  also  found 
in  most  of  the  organs  of  the  thorax  and  abdomen.  From  a 
black  child,  five  years  of  age,  a patient  of  Dr.  M.  S.  Perry  ; 
no  symptoms  particularly  referrible  to  the  heart.  1839. 

357.  Organic  disease  of  the  heart;  fibrine  upon  the  inside  of  the 
left  auricle,  becoming  organized,  with  some  ossific  deposit.  The 
patient  was  a female,  aged  forty-one,  and  had  been  under  the 
care  of  Dr.  Charles  E.  Ware ; was  first  seen  by  him  for 
haemorrhage  from  the  bowels,  in  November,  1836 : at  that  time 


HEART  AND  BLOOD-VESSELS. 


87 


she  became  very  livid  on  the  least  exertion ; had  had  dyspnoea 
and  palpitation,  with  oedema  of  the  feet,  for  many  years ; pulse 
felt  at  wrist,  but  could  not  be  counted ; sounds  of  heart  audible 
in  every  part  of  chest,  the  second  being  the  loudest,  but  with- 
out any  abnormal  sound.  The  haemorrhage  was  relieved,  and 
she  was  not  seen  again  till  January,  1839  ; had  been  pretty 
comfortable,  and  about  her  business  till  five  weeks  previously, 
when  the  dyspnoea  and  palpitation  became  more  urgent,  with 
lividity  on  motion,  as  before,  and  great  oedema  of  lower  ex- 
tremities. Physical  signs  and  pulse  as  before ; impulse  of 
heart  strong ; both  sounds  distinct,  and  without  bellows  mur- 
mur. In  the  course  of  February  there  came  on  effusion  in 
the  chest,  and  she  died  suddenly  on  the  last  day  of  the  month. 

On  dissection,  the  heart  was  of  about  the  usual  size.  Right 
auricle  and  ventricle  somewhat  hypertrophied,  but  the  left 
ventricle  decidedly  small  and  thin.  Mitral  valve  much  thick- 
ened, and  condensed,  with  considerable  ossification,  the  passage 
appearing  as  a narrow  slit,  into  which  the  tip  of  the  little  finger 
would  scarcely  enter.  Some  dilatation  of  pulmonary  artery 
and  aorta,  with  ossification  of  the  last,  the  valves  being  healthy. 
The  lining  membrane  of  the  left  auricle  had  an  opaque,  white, 
thickened,  soaked  appearance.  Upon  the  inner  surface  of  this 
last  cavity  was  a thin  layer  of  fibrine,  from  half  a line  to  a line 
in  thickness,  and  in  extent  three  inches  by  from  one  to  one  and 
a half  inches  ; appeared  at  first  sight  unorganized,  though  evi- 
dently formed  before  death ; free  surface  generally  rough,  and 
somewhat  colored  by  blood,  but  towards  the  edges  smooth, 
polished,  and  lost  in  the  surrounding  membrane,  though  the 
line  of  demarcation  was  sufficiently  distinct;  separated  very 
readily  for  the  most  part,  and  the  inner  surface  of  the  auricle 
appeared  then  as  it  did  elsewhere.  Just  as  the  fibrine  was 
about  to  terminate  in  the  surrounding  membrane,  but  distinctly 
in  its  substance,  and  very  near  to  the  cut  edge,  there  was  a 
well-formed,  ossific  plate,  measuring  one  line  by  one  and 
three-fourths,  and  perfectly  resembling  those  which  are  so 
often  found  on  the  inside  of  the  aorta ; there  was  also  another 
similar  plate,  three  and  a half  lines  in  length  by  one  to  one 
and  a half  lines  in  width,  at  some  distance  from  the  first,  and 
apparently  in  the  substance  of  the  fibrinous  deposit  just  before 
it  was  lost  in  the  inner  surface  of  the  auricle ; both  of  these 


88 


HEART  AND  BLOOD-VESSELS. 


may  be  seen  in  the  preparation.  The  under  surface  of  the 
fibrine,  where  it  was  stripped  up,  was  unequivocally  vascular, 
the  appearance  being  compared  to  that  of  an  inflamed  con- 
junctiva ; there  were  distinctly  seen  by  the  naked  eye,  though 
still  more  with  the  aid  of  a lens,  small  vessels  ramifying  and 
inosculating  with  each  other,  and  filled  with  red  blood,  which 
moved  freely  about  as  the  position  of  the  parts  was  altered, 
the  surface  generally  not  being  red  ; numerous  very  delicate 
filaments  passed  from  the  fibrine  to  the  inner  surface  of  the 
auricle,  but  into  these  the  blood  could  not  be  made  to  enter. 
In  the  preparation  the  left  auricle  and  the  mitral  valve  only  are 
preserved,  showing  the  fibrinous  deposit  and  the  ossification  in 
its  substance.  1839. 

358.  A large  tumor  in  the  cavity  of  the  left  auricle  of  the  heart ; 
perhaps  of  a malignant  nature.  From  a female,  aged  sixty- 
two,  a patient  of  Dr.  William  Ingalls ; had  had  disease  about 
the  elbow  for  the  last  seven  years,  confined  to  the  soft  parts, 
and  forming  a mass  at  the  time  of  death  as  large  as  the  foetal 
head  and  of  a highly  malignant  appearance.  Pulse  always 
regular;  generally  full  and  strong,  but  of  late  had  lost  this 
character ; frequency  not  remarkable.  Some  oppression  about 
chest,  and  cough  towards  the  last ; kept  about  till  the  last 
month,  and  was  confined  to  her  bed  for  a few  days  only. 

The  examination  after  death  was  made  by  Dr.  Winslow 
Lewis,  who  sent  the  specimen  to  the  Society.  The  tumor  was 
about  the  size  of  a pullet’s  egg,  of  a rounded  form,  uneven  on 
the  surface,  having  the  consistence  of  fibrine,  and  light  colored, 
though  not  white  like  the  disease  in  the  lung,  and  not  perfectly 
opaque  ; no  encephaloid  nor  scirrhous  appearance,  so  far  as 
could  be  seen  without  cutting  it  through.  The  mass  hung 
perfectly  loose  in  the  cavity  of  the  auricle,  being  suspended  by 
a prolongation  which  extended  about  half  an  inch  into  the  pul- 
monary vein  from  the  left  lower  lobe,  and  adhered  to  its  inner 
surface ; no  prolongation  into  the  vein  from  the  upper  lobe, 
nor  was  any  disease  found  in  the  branches  of  the  pulmonary 
artery.  The  heart  itself  was  perfectly  healthy.  In  the  lower 
lobe  of  the  left  lung  was  a mass  of  disease,  about  two  inches 
in  diameter,  peculiar  in  its  appearance,  but  undoubtedly  of  a 
malignant  character ; this  was  not  connected  with  the  pulmo- 


HEART  AND  BLOOD-VESSELS. 


89 


nary^  veins,  so  far  as  could  be  ascertained.  Two  or  three 
other  similar  masses  were  found  in  the  same  lobe,  about  six  or 
eight  lines  in  diameter,  one  of  them  hanging  pendulous  from 
the  external  surface  of  the  lung. 

The  left  auricle  of  the  heart  and  the  greater  part  of  the 
lower  lobe  of  the  left  lung  are  preserved,  showing  the  disease 
in  each,  and,  two  or  three  of  the  branches  of  the  pulmonary 
vein  being  cut  open,  the  prolongations  from  the  tumor  are 
distinctly  seen.  Cruveilhier  (Anat.  Path.  liv.  xxix.)  figures  a 
“polypifonn  cancer”  in  the  right  auricle,  the  heart  not  having 
been  suspected  during  life. 

359.  Ossification  of  the  coronary  artery,  from  an  old  gentleman, 
who  for  many  years  had  been  subject  to  embarrassment  about 
the  heart,  with  irregular  pulse.  The  heart  itself  was  much 
enlarged,  but  the  artery  only  has  been  preserved.  1837. 

Dr.  J.  B.  S.  Jackson. 


hi.  Arteries. 

360.  A coagulum  in  the  femoral  artery,  from  a patient  who  died  a 
few  days  after  amputation  of  the  thigh.  Dr.  J.  H.  Lane. 

361.  Inflammation  of  the  iliac  and  femoral  arteries.  From  a 
female,  aged  thirty,  who  entered  the  Mass.  Gen.  Hospital 
Aug.  28th,  1838,  for  hemiplegia  of  right  side.  About  a week 
before  death  a diffused  redness  was  noticed  over  the  lower  part 
of  the  left  leg  and  top  of  the  foot;  this  disappeared,  and 
returned  several  times,  but  for  the  last  four  days  was  constant, 
and  accompanied  with  swelling,  though  without  heat  or  any 
indication  of  pain. 

On  dissection,  there  was  found  a well-defined,  livid  redness 
of  the  lower  third  of  the  left  leg  and  top  of  foot,  with  conside- 
rable serous  infiltration ; there  was  some  redness,  also,  about 
the  right  knee.  The  left  hemisphere  of  the  brain  was  exten- 
sively softened,  and  upon  the  mitral  valve  were  numerous  and 
large  vegetations. 

The  iliac  arteries,  on  both  sides,  were  plugged  up  with  a 
mixture  of  fibrine  and  coagulated  blood,  extending  into  the 
aorta  about  an  inch,  into  the  upper  part  of  the  right  femoral 
12 


90 


HEART  AND  BLOOD-VESSELS. 


artery,  and  far  down  the  femoral  on  the  left  side.  In  the  left 
groin,  where  the  disease  was  most  advanced,  the  fibrine  was 
softened  and  mixed  with  a substance  like  thick  pus,  some 
appearance  of  this  last  being  also  found  in  the  iliac  arteries.  Be- 
fore being  cut  open,  the  vessels  appeared  contracted,  and  had  a 
corded  feel ; parietes  very  little  if  at  all  thickened ; fibrine  and 
coagulum  separated  readily,  leaving  the  inner  surface  perhaps 
a little  rough,  but  not  red,  the  experiment  being  made  in  seve- 
ral places.  In  the  preparation,  the  left  iliac  arteries  and  the 
femoral,  part  of  the  right  iliac,  and  the  lower  part  of  the  aorta 
are  shown ; the  disease  is  seen  to  have  extended  into  the  pro- 
funda, and  one  of  the  femoral  veins  is  similarly  affected. 
Having  been  put  directly  into  alcohol,  the  color  of  the  coagu- 
lum is  somewhat  preserved. 

362.  Several  dried  specimens,  showing  very  extensive  ossification 
of  the  aorta  and  smaller  vessels ; from  different  subjects. 

Dr.  J.  B.  S.  Jackson. 

363.  Complete  ossification  of  the  arteries  of  the  leg  and  lower  part 
of  the  thigh,  from  a case  of  extensive  gangrene  of  the  ex- 
tremities. ■ The  arteries  have  been  dissected  out,  dried,  and 
displayed  upon  a black-board.  The  patient  was  a negro,  aged 
sixty-one,  and  had  been  under  the  care  of  Dr.  Ebenezer  Alden, 
of  Randolph.  In  September,  1839,  he  had  pretty  severe  pain 
in  the  left  great  toe ; this  soon  vesicated,  the  end  dried  up,  and 
became  quite  black,  and  from  that  time  the  gangrene  gradually 
extended  up  the  foot  and  leg.  When  Dr.  A.  first  saw  him,  in 
October,  the  arteries  everywhere  felt  hard ; pulsation  not 
strong  in  carotids,  still  less  so  in  axilla  and  groin,  and  in  the 
wrists  it  could  never  be  felt.  The  cardiac  region  was  enlarged, 
and,  on  percussion  over  the  heart,  the  resonance  was  very  loud 
and  tympanitic ; impulse  not  felt,  but  the  sounds  of  the  heart 
were  distinct,  though  they  seemed  distant;  these  observations 
were  frequently  repeated.  No  palpitation  nor  dyspnoea.  For 
the  last  two  months  the  left  lower  extremity  was  gangrenous 
as  high  as  the  knee ; right  foot  and  lower  half  of  leg  also  gan- 
grenous for  some  months,  and  for  about  two  weeks  before 
death  the  hands  and  part  of  the  fore-arms  had  become  shrivelled 
and  dried  up.  The  patient  had  pain,  but  Dr.  A.  could  not 


HEART  AND  BLOOD-VESSELS. 


91 


ascertain  how  much,  as  he  never  made  the  least  complaint. 
Died  of  acute  pneumonia,  in  July,  1840. 

After  death  the  left  lower  extremity  was  removed  four 
inches  above  the  knee-joint,  and  brought  to  the  city  for  the  use 
of  the  Society;  the  heart  also  was  removed.  Foot  perfectly 
black  and  dry  as  a mummy’s,  the  integument  having  separated 
from  the  dorsum.  Ancle-joint  largely  open,  and  the  tibia  and 
fibula  exposed  to  a considerable  extent.  Surface  of  leg  black, 
but  less  so  than  the  foot ; muscles  and  tendons  of  lower  half 
exposed  to  a great  extent,  soft,  very  pale,  and  surrounded  by  a 
yellowish,  viscid  pus,  but  towards  the  upper  part  more  healthy. 
Posterior  tibial  nerve  at  ancle  quite  large  and  infiltrated  with 
pus.  Arteries  carefully  dissected  out,  and  found  completely 
ossified,  except  to  a small  extent  in  the  ham,  as  shown  in  the 
preparation;  Dr.  A.  found  the  femoral  higher  up  in  the  same 
condition.  Charcoal,  creosote,  &c.,  having  been  freely  used, 
the  parts  were  not  veiy  offensive. 

On  examination  of  the  chest,  to  ascertain  the  cause  of  the 
physical  signs  above  referred  to,  Dr.  A.  found  the  cavity  of  the 
pericardium  very  large,  and  as  if  distended  with  air,  though  it 
was  not  ascertained,  on  puncturing  it,  that  this  was  actually  the 
case ; quantity  of  serum  small.  Heart  healthy,  except  for 
slight  ossification  of  one  of  the  column®  in  left  ventricle; 
large  quantity  of  fibrine  in  all  of  the  cavities,  and  especially  in 
the  ventricles.  In  the  thoracic  aorta,  which  has  been  preserved, 
there  was  scarcely  a trace  of  ossification,  notwithstanding  the 
condition  of  the  smaller  vessels;  valves  healthy.  As  the  im- 
mediate cause  of  death,  there  was  found  an  extensive  purulent 
infiltration  in  one  of  the  lungs. 

364.  Rupture  of  the  aorta  into  the  pericardium,  from  a man  who 
dropped  dead  in  the  street ; a patient  of  Dr.  Henry  G.  Clark. 
“Nothing  known  of  his  history,  except  that  he  was  intemperate, 
and  had  not  made  much  complaint.  The  cavity  of  the  peri- 
cardium was  found  filled  with  blood ; heart  large,  and  the  left 
ventricle  dilated  and  hypertrophied.”  The  ascending  aorta 
only  is  preserved,  and  is  seen  to  be  generally  somewhat  dis- 
eased, though  not  ossified.  The  perforation  is  one-fourth  of 
an  inch  above  the  valves,  quite  small,  and  situated  at  the  bottom 
of  something  like  an  ulceration  two  or  three  lines  in  diameter, 
the  corresponding  portion  externally  being  thickened,  and 


92 


HEART  AND  BLOOD-VESSELS. 


decidedly  softened.  Near  the  perforation,  and  upon  the  inner 
surface,  are  two  small  diseased  spots,  probably  an  early  stage 
of  the  same  process.  Cruveilhier  remarks  (Anat.  Path.  liv.  iii.) 
that  the  arteries,  and  especially  the  aorta,  burst  not  unfrequently 
from  structural  change,  and  without  previous  dilatation.  1827. 

365.  A second  specimen  of  rupture  of  the  aorta  into  the  peri- 
cardium, from  a patient  of  Dr.  John  Jeffries.  The  artery  is 
greatly  diseased,  and  more  or  less  dilated,  measuring  at  the 
arch,  when  cut  open,  from  five  to  six  inches  across.  About 
two  inches  and  a half  above  the  valves  there  is  a ragged  lacer- 
ation, large  enough  to  admit  the  end  of  the  finger,  the  parietes 
of  the  vessel  about  the  rent  being  completely  disorganized. 
The  cavity  of  the  pericardium  contained  about  a pint  and  a 
half  of  blood.  The  heart  was  healthy,  but  the  valves  of  the 
pulmonary  artery  were  considerably  perforated,  and  those  of 
the  aorta  were  somewhat  diseased.  In  the  preparation  the 
artery  only  has  been  preserved.  The  patient  was  a gentleman, 
sixty-one  years  of  age,  always  very  anxious  about  himself, 
and  had  had  occasionally,  of  late,  a “ catching  pain”  about  the 
region  of  the  heart,  but  no  other  cardiac  symptoms,  so  far  as 
was  known.  For  many  years  he  had  been  much  addicted  to 
the  habit  of  smoking,  and  to  the  use  of  strong  coffee,  and  as  a 
consequence  probably,  he  had  been  subject  to  a remarkable 
tremor  of  the  hands.  His  death  was  at  last  almost  instanta- 
neous. 1846. 

Since  the  above  case  two  others  have  occurred  in  this  city, 
and  both  upon  the  same  day.  One  of  the  patients  was  a 
gentleman,  aged  fifty-one,  who  had  had  cardiac  symptoms,  but 
was  about  his  business,  when  he  dropped  dead ; the  laceration 
was  large,  but  the  aorta  was  no  more  diseased  than  it  often  is 
in  one  of  his  age.  The  other  was  a black  woman,  aged  about 
ninety,  and  regarded  as  healthy  for  her  years ; she  also  died 
instantly,  but  the  aorta  in  her  case  was  much  dilated  and  dis- 
eased, though  the  opening  was  a mere  pin  hole.  Both  speci- 
mens were  shown  at  the  same  meeting,  (January  11th,  1847.) 

366.  Laceration  of  the  aorta  just  above  the  valves.  From  a man, 
aged  forty-one,  a patient  of  Dr.  Sylvanus  Plympton,  of  Cam- 
bridge. After  a hearty  dinner  of  baked  beans  he  went  to  the 


HEART  AND  BLOOD-VESSELS. 


93 


printing  office,  where  he  worked,  but  vomited  freely,  and  was 
obliged  to  return  home.  The  vomiting  continued  most  of  the 
night,  and  on  the  following  morning  he  had  nausea,  distress  at 
the  prsecordium,  an  anxious  countenance,  and  a small  but 
regular  pulse ; Dr.  P.  was  called,  and  regarding  it  as  a case  of 
disordered  stomach,  ordered  a purgative  of  calomel  and  jalap. 
At  eight,  A.  M.,  he  was  left  alone  for  twenty  minutes,  and,  on 
returning  to  his  room,  the  attendant  found  him  dead.  The 
dissection  was  made  by  Dr.  Morrill  Wyman,  who  sent  the 
specimen  to  the  Society.  The  laceration  was  transverse, 
ragged,  and  involved  about  two-thirds  of  the  circumference  of 
the  vessel.  The  coats  of  the  ascending  aorta  were  veiy  ex- 
tensively separated  by  the  blood  which  had  been  forced  in 
between  them,  and  which  had  been  driven  along  the  parietes 
of  the  right  carotid  and  subclavian  arteries.  Just  beyond  the 
left  subclavian  was  a second,  recent,  transverse  laceration  of 
the  inner  coat  of  the  aorta  one  inch  in  extent,  and  evidently 
formed  by  the  blood,  as  it  burst  through  into  its  former  chan- 
nel. If  the  patient  had  lived,  then,  the  case  would  have 
resulted  in  one  of  dissecting  aneurism.  Some  chronic  disease 
of  aorta  exists,  but  not  more  than  is  often  found.  The  peri- 
cardium contained  probably  not  less  than  gviij.  of  yellow  fluid, 
but  no  blood,  though  there  was  a considerable  effusion  of  this  last 
into  the  .loose  cellular  membrane  about  the  origin  of  the  aorta 
and  pulmonary  artery.  Left  ventricle  dilated  and  hyper- 
trophied, but  the  heart  was  otherwise  sufficiently  well.  In  the 
preparation,  the  aorta  and  its  branches  only  are  shown. 

This  case  differs  in  two  very  important  points  from  several 
which  have  been  published  by  Prof.  Roldtanski,  of  Vienna, 
(Encyclographie  des  Sc.  Med.,  April,  1840,)  also  from  one  by 
Cruveilhier,  (Anat.  Path.  liv.  xx.)  and  one  by  Dr.  Boyd,  (Edin- 
burgh Jour,  of  Med.  and  Surg.,  April,  1841);  in  nearly  every 
one  of  these  the  blood  was  effused  into  the  pericardium,  as 
might  be  expected,  and  in  no  one  is  there  stated  to  have  been 
a second  laceration  or  re-opening  into  the  aorta. 

One  other  case,  similar  to  the  above  in  the  circumstance  of 
there  being  no  rupture  into  the  cavity  of  the  pericardium, 
occurred  in  November,  1842,  in  the  practice  of  the  late  Dr. 
Charles  O.  Barker,  of  Lynn,  who  sent  the  specimen  to  the 
Society,  with  a history  of  the  case.  The  laceration  was  just 


94 


HEART  AND  BLOOD-VESSELS. 


above  the  valves,  and  opened  into  a large  cavity,  which  was 
filled  with  blood,  and  formed  upon  the  outside  of  the  aorta  by 
a detachment  of  the  serous  membrane.  The  heart  itself  was 
healthy,  and  there  were  only  traces  of  chronic  disease  in  the 
aorta  and  pericardium.  The  patient  was  a lad,  nineteen  years 
of  age,  who  had  previously  been  regarded  as  healthy,  and  died, 
after  an  illness  of  five  hours,  with  great  distress  in  the  region 
of  the  heart. 

367.  Dissecting  aneurism.  The  false  passage  commences  near  the 
origin  of  the  aorta,  and,  as  in  the  last  case,  opens  into  the  arch 
just  beyond  the  left  subclavian  artery ; the  transverse  diameter, 
inferiorly,  is  nearly  two  inches,  but,  at  the  outlet,  it  diminishes 
about  one-half,  the  septum,  which  was  at  first  quite  thick, 
becoming  veiy  thin.  Below  this  passage  the  lacerated  edges 
are  separated  to  some  extent,  and  the  external  portion  of  the 
artery  is  much  dilated,  terminating  in  a broad  but  shallow  aneu- 
rismal  pouch  just  above  the  valves.  Circumference  at  the 
valves  four  inches,  and  at  the  dilated  part  more  than  seven. 
The  inner  surface  of  this  last,  and  of  the  false  passage  has  a 
cicatrized  appearance,  showing  the  chronic  nature  of  the 
affection,  and  the  cavity  of  the  false  passage  is  traversed  by 
bands  resembling  the  chordae  tendinese  of  the  heart.  The  true 
inner  surface  of  the  ascending  aorta  is  nearly  healthy,  as  are 
also  the  valves,  though  in  the  descending  aorta  are  seen  nume- 
rous, large,  atheromatous  deposits.  The  heart  was  enlarged, 
the  left  ventricle  being  thickened  and  dilated.  Pericardium 
coated  with  lymph  and  enormously  distended  with  bloody 
serum,  of  which  there  were  by  measurement  between  three 
and  four  pints.  Serous  effusion  in  pleural  cavities,  and  exten- 
sive oedema  of  lower  extremities.  The  aorta  only  has  been 
preserved. 

From  a gentleman,  aged  thirty-three  years,  a patient  of  Dr. 
John  Homans.  Health  failing  for  more  than  two  years,  and 
distinct  cardiac  symptoms  for  the  last  eighteen  months.  Palpita- 
tion and  dyspnoea  from  the  first,  and  for  the  last  four  months  he 
could  not  lie  down  in  bed;  enlargement  in  cardiac  region; 
pulse  irregular  for  the  last  two  weeks,  but  previously  not 
remarkable  ; complexion  pale,  but  not  livid ; had  had  ascites, 
which  had  disappeared. 


HEART  AND  BLOOD-VESSELS. 


95 


368.  Aneurism  at  the  origin  of  the  aorta,  bursting  into  the  pericar- 
dium ; from  a patient  of  Dr.  John  Ware.  The  sac  is  about 
the  size  of  an  English  walnut,  and  communicates  with  the 
artery  just  above  the  valves  by  an  opening  one  third  of  an 
inch  in  diameter  ; edges  rounded,  and  to  some  extent  within 
the  orifice  the  inner  surface  is  smooth ; at  its  thinnest  part 
there  is  a ragged  opening  into  the  pericardium,  and  it  seems 
also  about  ready  to  burst  into  the  pulmonary  artery,  as  some- 
times happens  in  these  cases.  The  cavity  of  the  pericar- 
dium contained  more  than  a quart  of  coagulated  blood.  In  the 
preparation  the  vessels  only  are  preserved. 

The  patient,  aged  thirty,  was  an  officer  in  one  of  the  Banks 
in  this  city.  Was  first  seen  by  Dr.  W.  in  May,  1832;  had 
been  indisposed  for  some  months,  but  had  not  thought  much  of 
his  case  till  within  a few  weeks ; complained  chiefly  of  pains 
and  stiffness  in  all  the  limbs,  and  of  a great  and  general  feel- 
ing of  weakness,  but  scarcely  of  anything  else ; had  lost  flesh, 
and  his  countenance,  which  in  health  was  remarkably  ruddy, 
was  now  pallid  and  thin ; on  examination  of  the  heart  there 
was  no  increased  impulse,  but  a slight  bellows  or  rasping  sound 
was  heard  on  the  left  side,  and  seeming  to  occur  between  the 
two  sounds.  This  sound  was  invariably  heard  during  the  two 
months  of  Dr.  W.’s  attendance,  but  otherwise  nothing  pointed 
to  the  heart  as  the  seat  of  disease.  The  only  additional  symp- 
tom during  this  period  was  a considerable  tenderness  across  the 
lower  part  of  the  chest,  in  consequence  of  which  a disagreeable 
sense  of  jarring  was  occasioned  by  walking,  or  by  any  sudden 
motion.  About  the  end  of  July  he  returned  to  his  business. 
He  however  grew  more  feeble,  complaining  of  excessive 
weakness  and  faintness,  and  of  great  soreness  across  the  chest. 
November  1st,  he  died  instantly,  whilst  conversing  with  a per- 
son at  the  Bank.  This  case  was  published  more  fully  in  the 
Boston  Medical  and  Surgical  Journal  for  March  27th,  1833. 

369.  False  aneurism  of  the  ascending  aorta;  the  anterior  portion  is 
mostly  involved  in  the  disease,  the  vessel  itself  having  on  its 
inner  surface  an  opaque,  rough,  inelastic  appearance,  but  no 
ossific  deposit.  From  a female,  aged  fifty-seven,  a patient  of 
Dr.  Charles  G.  Putnam.  In  1829,  Dr.  P.  found  her  with  con- 
stant cough,  .palpitation,  and  some  dyspnoea ; at  the  third  rib 


96 


HEART  AND  BLOOD-VESSELS. 


on  the  left  side,  two  or  three  inches  from  the  sternum,  was  a 
diffused  enlargement  with  a strong  pulsation ; she  was  much 
relieved  by  bleeding  and  the  use  of  digitalis.  In  June,  1831, 
her  condition  was  much  worse ; left  side  of  chest  one  inch 
and  a half  larger  than  the  right;  sound  of  heart  noisy,  and 
impulse  strong ; resonance  on  percussion  natural,  except  over 
region  of  tumor ; respiration  on  left  side  feeble,  and  on  the 
right  puerile.  In  February,  the  respiration  on  the  left  side 
was  inaudible,  with  dulness  on  percussion ; she  was  pale  and 
emaciated,  but  the  muscular  strength  was  good  ; pulse  frequent 
and  rather  hard.  Died  suddenly,  July  5th,  1832,  whilst  going 
to  the  pump  for  a pail  of  water. 

On  raising  the  sternum,  the  aneurismal  sac  was  found  to  be 
connected  with  it  and  the  ribs  by  a thick,  adventitious  mem- 
brane, extending  into  the  left  side  of  the  chest  so  as  completely 
to  occupy  the  place  of  the  lung ; a portion  of  the  sternum  and 
of  the  third  rib  absorbed.  The  heart  with  its  valves,  and  the 
aorta  beyond  the  aneurism  were  healthy,  the  heart  being 
shown  in  the  preparation  as  well  as  the  diseased  artery. 

370.  Mixed  aneurism  of  the  ascending  aorta ; specimen  distended 
and  dried;  from  a patient  of  Dr.  Woodbridge  Strong.  The 
whole  ascending  aorta  was  dilated.  Upon  its  right  side,  and 
towards  the  front,  there  was  found  a true  aneurism,  about  half 
as  large  again  as  the  fist,  and  upon  this  was  engrafted  a false 
aneurism  about  one-third  its  size ; this  last  adhered  to  the 
the  right  lung,  the  right  side  of  the  sternum  and  the  cartilages 
of  three  of  the  ribs  forming  in  part  the  parietes  of  the  sac. 
Sac  protruded  and  threatened  to  burst  between  the  cartilages 
of  the  third  and  fourth  ribs,  as  shown  in  the  preparation  by  a 
defined  bulging  out  at  this  part,  there  being  a flatness  on  per- 
cussion on  the  right  of  the  sternum,  but  without  any  obvious 
enlargement.  Just  above  the  aortal  valves  there  was  a dilata- 
tion, distinct  from  the  aneurism,  and  about  half  as  large  as  the 
fist.  The  aorta  throughout  contained  a considerable  quantity  of 
atheromatous  and  cretaceous  matter,  and  some  of  the  same 
was  found  in  what  was  regarded  as  the  false  aneurism.  The 
heart  was  rather  large,  and  filled  with  blood;  left  ventricle 
thickened ; valves  healthy.  The  aneurism  did  not  appear  to 
press  particularly  upon  the  air-passages,  nor  upon  the  cesoph- 


HEART  AND  BLOOD-VESSELS. 


97 


The  patient  was  a laboring  man,  about  fifty  years  of  age, 
and  the  aneurism  first  appeared  externally  about  four  years 
before  death,  when  the  chief  symptoms  were  dyspnoea  and 
dysphagia.  He  kept  about,  but  had  not  done  much  work  for 
the  last  year,  and  died  at  last  of  acute  pneumonia.  1840. 

371.  Very  great  and  regular  dilatation  of  the  entire  circumference 
of  the  ascending  aorta  and  arch,  the  internal  surface  being 
everywhere  much  diseased.  Descending  aorta  healthy ; per- 
haps small,  and  becomes  rather  abruptly  so.  The  heart  itself 
is  very  small,  and  the  left  auricle  and  ventricle  are  laid 
open.  The  aorta,  at  its  origin,  is  of  about  the  usual  size. 

Dr.  Winslow  Lewis. 

372.  Aneurism  of  the  arch  of  the  aorta,  bursting  into  the  left  pri- 
mary bronchus.  Just  beyond  the  left  subclavian  artery  is  a 
well  marked  dilatation  of  a portion  of  the  circumference  of  the 
vessel,  to  the  extent  of  about  two  inches  and  a third,  and  upon 
this  are  engrafted  two  small,  false  aneurisms,  one  of  which  is 
closely  connected  with  the  membranous  portion  of  the  trachea 
at  its  lowest  part,  and  the  other  with  the  left  primary  bronchus. 
At  this  part  the  bronchus  was  completely  filled  by  a firm  mass, 
one  inch  and  a half  in  length,  consisting  partly  of  fibrine,  partly 
of  coagulated  blood,  and  evidently  formed  long  before  death ; 
the  point  at  which  this  obstruction  finally  gave  way  was  readily 
discovered  at  the  time  of  the  dissection.  There  were  also  two 
false  aneurisms  arising  from  the  abdominal  aorta,  of  a rounded 
form,  and  about  one  inch  and  a half  in  diameter ; one  was 
situated  at  the  coeliac,  and  the  other  at  the  superior  mesenteric 
artery,  and  both  of  these  vessels  were  obliterated.  Thoracic 
aorta  generally  somewhat  diseased  in  structure.  The  bronchi 
contained  much  coagulated  blood,  mostly  on  the  right  side. 
High]  lung  healthy,  but  the  left  greatly  diseased,  being  filled 
with  small  suppurating  cavities,  of  the  nature  of  which  there 
was  some  question.  In  the  preparation,  the  whole  aorta,  the 
trachea,  and  the  primary  bronchi  are  shown. 

The  patient,  aged  thirty,  entered  the  Mass.  Gen.  Hospital, 
July  25th,  1835.  He  had  had  severe  pain  in  abdomen  or  epi- 
gastrium for  about  five  months,  and  for  the  last  month  cough 
with  expectoration.  Had  done  no  work  for  the  last  nineteen 
13 


98 


HEART  AND  BLOOD-VESSELS. 


days.  After  his  admission  the  cough  and  dyspnoea  were  very 
severe,  coming  on  in  paroxysms,  and  sometimes  having  a 
laryngeal  character;  there  was  much  pain  and  tenderness  on 
pressure  about  the  epigastrium,  and  much  constitutional  affec- 
tion. Disease  in  the  left  side  of  chest  ascertained  by  physical 
examination,  but  aneurism  never  suspected.  On  the  26th  of 
November,  he  was  seized  in  the  evening  with  a violent  fit  of 
coughing,  during  which  there  came  on  active  hsemoptisis ; 
more  than  a pint  of  blood  poured  out  without  effort,  and  he 
died  in  less  than  fifteen  minutes.  A full  history  of  the  case  is 
in  the  Hospital  Records. 

373.  A second  specimen  of  aneurism,  bursting  into  the  left  primary 
bronchus ; from  a patient  of  Dr.  Joseph  Roby.  The  aorta  is 
dilated  from  its  origin  to  some  distance  beyond  the  arch,  and 
most  so  at  the  arch,  from  which  there  arise  two  false  aneurisms, 
nearly  half  as  large  as  the  fist;  one  of  these,  as  is  seen  in  the 
preparation,  adheres  to  the  upper  part  of  the  sternum.  The 
concave  part  of  the  arch  pressed  upon  the  left  primary  bron- 
chus, into  which,  almost  at  the  bifurcation,  the  rupture  took 
place.  Upon  the  inner  surface  of  the  oesophagus  is  seen  a 
small  but  deep  ulcer,  communicating  with  the  bronchus  very 
near  to  the  opening  from  the  aneurism,  and  intended,  perhaps, 
to  open  into  the  aneurism  itself ; so,  in  a figure  by  Cruveilhier, 
(Anat.  Path.  liv.  iii.  pi.  4,)  ulcerations  are  seen  in  the  bronchus, 
whilst  the  aneurism  bursts  into  the  oesophagus,  the  reverse  of 
the  present  case.  The  trachea  and  bronchi  on  the  right  side 
were  filled  with  coagulated  blood ; the  right  lung  voluminous 
and  healthy,  the  left  smaller,  and  having  a flabby,  leathery  feel. 

The  patient,  a negress,  aged  sixty-four,  was  first  seen  by 
Dr.  R.  in  October,  1834,  for  supposed  rheumatism  of  the  left 
shoulder  and  side  of  the  neck.  In  October,  1835,  when  next 
seen,  she  stated  that  during  the  previous  winter  she  began  to 
have  dysphagia,  headache,  and  long  continued  pain  hi  neck 
extending  upwards  behind  the  left  ear.  For  a week  past  had 
had  orthopncea,  pain  and  oppression  at  bottom  of  sternum,  and 
loud,  tearing,  frequent  cough,  without  expectoration.  Never 
had  palpitation.  Dysphagia  at  times  great ; could  not  swallow 
a piece  of  meat  without  drinking,  and  was  often  extremely 
distressed  after  attempting  it.  On  examination  of  chest,  there 


HEART  AND  BLOOD-VESSELS. 


99 


was  found  on  the  left  of  the  sternum,  over  the  junction  of  the 
upper  and  middle  portions,  a decided  protrusion,  a stfong  im- 
pulse, and  a complete  and  well  defined  flatness  on  percussion. 
Respiration  heard  generally  over  left  side  with  sibilant  rale, 
and  puerile  with  noisy  rales  over  right.  No  bellows-sound. 
The  case  was  diagnosed  as  one  of  aneurism  at  the  arch  of  the 
aorta,  with  compression  of  the  left  lung  or  bronchi,  and  bron- 
chitis. From  the  above  date,  October,  1835,  the  principal 
symptoms  and  physical  signs  continued,  and  the  dysphagia  was 
particularly  urgent,  seeming  at  times  to  threaten  suffocation. 
February  22d,  1836,  whilst  conversing,  she  made  an  effort  to  rise, 
and  called  for  the  spit-cup,  when  a gush  of  blood  issued  from 
the  mouth  and  nose,  and  she  died  in  an  instant;  not  more  than 
half  a pint  of  blood  was  discharged  externally. 

374.  An  immense  aneurism  of  the  upper  part  of  the  abdominal 
aorta,  extending  towards  the  left  side,  and  destroying  all  the 
parts  before  it,  till  the  ribs,  muscles,  and  skin  came  to  form  a 
part  of  the  sac,  as  shown  in  the  preparation ; two  of  the  ribs, 
and  the  bodies  of  three  or  four  of  the  vertebrse  are  extensively 
eroded,  the  intervertebral  substance  remaining  comparatively 
untouched.  The  communication  with  the  aorta  is  not  very 
free,  and,  in  fact,  the  situation  of  the  aneurism  is  such  that  it 
may  have  been  the  left  renal  artery  in  which  the  disease  began ; 
the  right  side  of  the  aorta,  opposite  the  great  sac,  is  beginning 
to  be  aneurismal.  The  size  of  the  tumor  could  not  be  cor- 
rectly determined,  but  it  extended  into  the  abdominal  cavity, 
presenting  there  a larger  surface  than  posteriorly  and  externally. 

The  patient  was  a sailor,  aged  forty-one,  and  had  been 
under  the  care  of  Dr.  Edwin  Adams.  In  March,  1830,  he 
arrived  from  Cadiz,  after  a long  and  rough  passage.  Was 
soon  afterwards  attacked  with  pains,  chiefly  affecting  the  loins, 
which  returned  often  and  with  severity  till  the  following 
November.  On  the  14th  of  December  he  called  Dr.  A’s 
attention  to  a swelling  on  his  back,  which  he  said  had  appeared 
since  the  day  before  ; on  examination,  there  was  found  to  be  a 
tumor  upon  the  left  side,  near  the  spine,  and  opposite  the 
lowest  ribs,  about  the  size  of  a hen’s  egg,  pulsating,  and  evi- 
dently aneurismal.  This  went  on  increasing  rapidly,  so  as  to 
measure,  in  the  month  of  May,  from  fifteen  to  sixteen  inches  in 


100 


HEART  AND  BLOOD-VESSELS. 


diameter.  June  1st,  it  began  to  slough,  and  on  the  10th,  when 
it  was  about  ready  to  burst,  the  patient  died. 

375.  Aneurism  of  the  right  subclavian  artery ; from  a patient  of 
Dr.  J.  Greele  Stevenson.  Sac  about  as  large  as  an  orange, 
and  seems  to  be  formed  by  a dilatation  of  one  half  of  the  cali- 
bre of  the  vessel ; parietes  diseased.  From  a middle-aged 
female. 

376.  Aneurism  of  the  right  common  carotid,  about  midway.  It  is 

about  the  size  of  an  English  walnut ; has  not  been  opened,  but 
appears  to  be  filled  with  coagula ; surface  irregular,  and  the 
whole  calibre  of  the  vessel  is  more  or  less  affected.  A similar 
disease  is  commencing  at  the  bifurcation.  In  the  preparation, 
the  par  vagum  is  seen  to  be  attached  to,  and  spread  out  over 
the  sac.  Dr.  Winslow  Lewis. 


iv.  Veins. 

377.  Phlebitis.  The  specimen  shows  the  common  and  external 
iliac  veins  of  each  side  and  the  left  femoral  plugged  up  with 
fibrine  and  coagulated  blood ; the  same  extends  more  than  an 
inch  into  the  vena  cava,  where  is  seen  a large  cavity  in  the 
fibrinous  clot,  which,  in  the  recent  state,  was  filled  with  what  is 
often  described  as  pus.  (Cruveilhier’s  Anat.  Path.  liv.  xxvii.  pi.  4.) 
The  veins  throughout  the  left  lower  extremity  were  mostly  filled 
with  fibrine,  though  several  of  them  with  coagulated  blood  only. 
Below  the  groin,  where  the  disease  seemed  to  have  commenced, 
the  fibrine  was  adherent ; elsewhere  it  separated  readily  from 
the  coats  of  the  vessel,  leaving  the  inner  surface  in  some 
places  evidently  inflamed,  though  generally  quite  healthy  in 
appearance.  Veins  of  the  right  lower  extremity  not  exten- 
sively affected.  The  specimen  having  been  put  directly  into 
alcohol,  the  color  is  somewhat  preserved ; femoral  separated 
from  the  iliac  vein  for  the  convenience  of  the  preparation. 

From  a man,  aged  forty-eight,  who  entered  the  Mass.  Gen. 
Hospital,  October  10th,  1838,  in  the  last  stage  of  phthisis,  and 
died  November  21st.  For  the  last  three  weeks,  there  was 
frequently  recorded  cedema  with  soreness  of  the  lower  ex- 
tremities, and  in  each  groin  a hard,  knotted  cord,  extending 


HEART  AND  BLOOD-VESSELS. 


101 


downwards  about  six  inches ; swelling  of  left  extremity  very 
great,  and  extended  as  high  as  the  ilium. 

378.  Inflammation  of  the  lower  vena  cava.  Where  this  vessel 
passed  behind  the  liver,  it  was  about  half  as  large  as  the  wrist, 
and  felt  quite  firm,  being  completely  filled  by  lymph ; below 
this  it  was  rather  softer,  though  proportionably  large,  and  the 
fibrine  was  of  a dirty,  yellowish  color,  with  more  appearance 
of  blood ; the  iliac  and  renal  veins  were  distended  by  a thick, 
dark  brown,  grumous,  bloody  fluid,  with  some  soft  fibrine.  The 
parietes  of  the  vein  were  not  thickened,  but  the  inner  surface 
was  generally  rough,  and  towards  the  heart  could  not  be  sepa- 
rated from  its  contents;  in  the  preparation,  most  of  the  vessel 
has  been  preserved,  and  cut  open  so  as  to  show  the  fibrine  in 
situ.  The  heart  was  well,  but  on  looking  into  the  lower  cava, 
just  below  its  termination  in  the  auricle,  the  smooth,  rounded 
surface  of  the  fibrinous  plug  was  distinctly  seen.  The  lungs 
were  pretty  extensively  tuberculous,  and  there  was  a very 
peculiar  disease  of  the  glands  of  the  mesentery  and  upper  part 
of  the  abdomen,  forming  a mass  larger  than  the  fist,  and  con- 
sisting, for  the  most  part,  of  a grumous  substance  such  as  was 
found  in  the  veins.  Immediately  over  the  aorta,  however,  and 
connected  with  the  above  mass,  there  was  a great  quantity  of 
yellowish  concrete  substance,  apparently  consisting  of  chyle, 
which  had  been  arrested  in  the  lacteals  and  had  undergone  this 
change,  this  being  evidently  the  case  in  some  of  the  vessels 
which  were  more  distinctly  seen  in  the  mesentery. 

The  patient  was  a State  Prison  convict,  twenty-eight  years 
of  age,  and  had  been  sick  for  three  or  four  months ; at  first  he 
appeared  to  have  simple  fever,  but  gradually  sank  without  any 
marked  local  symptoms.  No  swelling  of  the  lower  extremities, 
nor  of  the  veins  was  ever  observed.  1844. 

379.  The  left  iliac  vein,  showing  the  result  of  puerperal  phlebitis 
which  occurred  about  nine  years  before  death ; the  patient 
suffered  for  a long  while  from  the  disease,  and  died  at  last  from 
puerperal  convulsions.  The  vena  cava  and  veins  upon  the 
right  side  were  healthy.  The  common  and  external  iliac  veins 
upon  the  opposite  side  appeared  contracted,  but,  on  being  cut 
open,  were  found  to  be  pervious  throughout,  and  sufficient  for 


102 


ORGANS  OF  SENSE. 


the  transmission  of  the  blood,  though  smaller  than  those  of  the 
opposite  side.  The  cavity  was  traversed  by  numerous  short 
filaments,  about  the  size  of  a common  sewing  thread,  running 
directly  across  the  course  of  the  vessel,  and  perfectly  free  ex- 
cept at  the  extremities  by  which  they  were  attached;  near 
the  vena  cava  these  had  nearly  disappeared.  A very  conspic- 
uous object  within  the  cavity  of  the  vein  was  a longitudinal 
and  well  marked  band,  three  or  four  inches  in  length,  forming, 
as  it  were,  a part  of  ‘the  parietes  of  the  vessel,  and  yet  appear- 
ing as  if  it  must  be  the  organized  remains  of  an  old  fibrinous 
coagulum ; from  this  band  several  of  the  filaments  arose. 
Inner  surface  of  the  vein  polished,  and  showing  every  appear- 
ance of  recovery  from  the  former  disease.  Left  inguinal  vein 
healthy,  and  the  internal  iliac  nearly  free.  1846. 

380.  Phlebolites,  from  various  subjects ; all  from  the  pelvic  veins ; 
vary  from  the  size  of  a mustard  seed  to  that  of  a pea;  one  of 
them  broken  open  to  show  the  concentric  layers  of  which  they 
are  composed.  Dr.  J.  B.  S.  Jackson. 


Y.  ORGANS  OF  SENSE, 
i.  Nervous  System. 

381.  Cranium  of  a child  sawed  open,  to  show  the  dura  mater,  falx, 
and  tentorium. 

382.  Extensive  ossification  of  the  dura  mater  on  each  side  of  the 

longitudinal  sinus.  Dr.  George  B.  Doane. 

383.  A second  specimen.  “ From  a young  woman  who  died  sud- 

denly after  complaining  of  intense  pain  in  the  head.  An 
abscess  was  found  in  the  middle  lobe  of  the  right  hemisphere 
containing  pus  and  blood.”  Dr.  F.  A.  Sumner. 

384.  A third  specimen  ; a large  and  thick  mass  of  solid  bone  in  the 
anterior  part  of  the  falx.  From  a man,  about  thirty-two  years 
of  age,  who  died  at  the  Mass.  Gen.  Hospital  of  phthisis;  no 
cerebral  symptoms,  so  far  as  known.  April,  1S34. 


ORGANS  OF  SENSE. 


103 


385.  A fourth  specimen ; a broad  lamina  of  bone  from  the  anterior 
part  of  the  falx.  From  a man  who  was  an  habitual  drunkard, 
and  had  had  delirium  tremens  several  times. 

Dr.  J.  B.  S.  Jackson. 

386.  Tumor  of  the  dura  mater,  from  a patient  of  Dr.  William 
Gordon.  The  following  notes  were  taken  at  the  time  of  the 
dissection  : — The  mass  is  of  a flattened  oval  form,  three  inches 
in  length,  two  inches  and  three  fourths  in  width,  and  an  inch 
and  a half  in  thickness,  with  numerous,  dilated,  thin  vessels 
creeping  over  its  surface,  which  is  irregular  or  bosselated.  It 
is  quite  dense  to  the  feel,  of  a mixed  white  and  red  color,  and, 
on  being  cut  through,  is  found  to  consist  almost  uniformly  of  a 
structure  not  unlike  condensed  cellular  tissue,  without  any  dis- 
tinct fibrous  or  carcinomatous  appearance.  It  arose  from  the 
dura  mater,  lining  the  frontal  bone  upon  the  right  side,  and 
pressed  down  upon  the  substance  of  the  brain  so  as  to  cause  a 
deep  and  permanent  excavation ; there  were  slight  adhesions  at 
this  part  to  the  surface  of  the  brain,  and  an  obliteration  of  the 
convolutions,  with  thinning  and  softening  of  the  grey  substance, 
the  softening  extending  at  one  part  to  the  depth  of  two-thirds 
of  an  inch.  Cruveilhier  and  Andral  both  speak  of  the  brain  as 
being  rather  atrophied  than  compressed  in  these  cases,  and  so 
account  for  the  comparative  latency  of  the  disease,  but,  in  the 
present  case,  the  right  hemisphere  was  so  far  compressed  as  to 
encroach  very  considerably  upon  the  left.  The  brain  and 
membranes  were  otherwise  healthy ; the  optic  nerves,  however, 
were  much  elongated  anterior  to  the  commissure,  though  not 
diminished  in  size.  The  cranium,  also,  was  healthy,  except  at 
the  part  corresponding  to  the  tumor,  where  there  was  on  the 
inner  surface  a growth  of  new  bone,  about  an  inch  in  extent, 
having  a crystallized  or  coral-like  appearance,  and  to  which  the 
dura  mater  closely  adhered,  (No.  387.) 

The  patient  was  rather  a large,  fleshy  woman,  thirty-two 
years  of  age  ; general  health  good.  Was  confined  a year  and 
a half  before  death  ; six  months  afterwards,  her  sight  became 
affected,  and  she  was  supposed  to  have  amaurosis,  dependent 
upon  nursing.  Dimness  of  vision  continued  from  that  time, 
the  left  eye  being  more  affected  than  the  right.  Six  weeks 
before  death  she  was  again  confined,  after  which  the  affection 


104 


ORGANS  OF  SENSE. 


increased,  so  that  she  was  at  times  totally  blind ; never  had 
double  vision.  No  affection  of  the  other  senses,  and  no  proper 
paralysis,  though  on  three  or  four  different  occasions,  previous 
to  her  last  confinement,  she  fell  in  the  street,  her  limbs  seem- 
ing to  give  way  beneath  her.  Had  also  more  or  less  headache 
throughout  her  sickness ; pain  mostly  about  the  temples,  and 
behind  the  ears,  but  no  more  on  one  side  than  the  other,  and 
never  urgent  until  her  last  confinement,  when  it  had  a decidedly 
neuralgic  character.  Patient  had  naturally  a lively  disposition, 
but  during  the  last  year  became  very  fractious,  and  occasionally 
made  a strange  remark;  was  also  quite  drowsy  for  some 
months  before  death,  so  that  she  would  often  fall  asleep  during 
the  day,  but  otherwise,  the  mind  was  not  affected.  After  her 
last  confinement  the  symptoms  became  altogether  much  worse, 
though  she  was  able  to  nurse  her  child,  attended  somewhat  to 
her  domestic  affairs,  and  was  never  confined  to  her  bed ; during 
this  period  she  never  walked  out,  but  a week  before  her  death 
she  rode  out  in  a sleigh,  and  enjoyed  it  much.  Retained  her 
appetite  to  the  last,  and  the  stomach  and  bowels  were  gener- 
ally well.  On  the  night  before  her  death  she  was  restless, 
and  towards  morning  had  some  convulsive  affection,  which  her 
husband  regarded  as  hysterical ; through  the  forenoon  she 
continued  in  a nervous  state  till  eleven  o’clock,  when  she  fell 
asleep  and  slept  for  two  hours ; she  then  awoke,  convulsions 
came  on,  followed  by  coma,  and  she  died  at  three  o’clock, 
December,  1842. 

387.  A portion  of  the  frontal  bone,  connected  with  the  above  case. 

388.  A portion  of  brain,  showing  the  fibrous  structure.  From  a 
child  who  died  of  hydrocephalus,  the  amount  of  serum  in  the 
ventricles  being  very  great,  and  the  brain  being  in  one  place 
but  about  three  lines  in  thickness,  as  shown  in  the  preparation. 

Dr.  Erasmus  D.  Miller , of  Dorchester. 

389.  Tubercular  masses  from  about  the  cerebellum.  The  patient 
was  a lad,  ten  years  of  age,  and  had  been  under  the  care  of 
Dr.  John  Ware ; severe  headache  and  vomiting  for  four  or  five 
months  were  the  chief  symptoms,  but  there  had  been  no  fail- 
ure of  the  intellect,  sensation,  or  power  of  motion.  In  the 


ORGANS  OF  SENSE. 


105 


cerebellum  were  five  masses,  from  one-half  to  three-fourths  of 
an  inch  in  diameter ; a smaller  one  in  the  left  crus,  and  upon 
the  under  surface  of  the  tentorium  near  the  left  temporal  bone, 
was  one  about  an  inch  in  length ; softening  had  commenced. 
The  case  was  published  in  the  Am.  Jour,  of  Med.  Sciences  for 
November,  1828. 

390.  Left  lobe  of  the  cerebellum,  containing  near  the  surface  two 
or  three  tubercular  masses,  about  half  an  inch  in  diameter,  of 
a rounded  form,  perfectly  defined,  quite  firm,  except  for  some 
central  softening  in  one  of  them,  and,  when  recent,  of  a green- 
ish yellow  color.  The  patient,  aged  twenty-three,  had  been 
under  the  care  of  Dr.  Henry  G.  Clark,  and  died  in  July,  1844, 
having  had  phthisical  symptoms  for  about  three  years.  For 
the  last  two  months  he  had  a severe  and  constant  pain  just 
about  over  the  left  lobe  of  the  cerebellum,  with  dizziness,  so 
that  he  sometimes  staggered  in  the  street.  Symptoms  of  acute 
disease  came  on  nine  days  before  death,  and,  on  dissection, 
there  were  found  the  usual  appearances  of  tubercular  menin- 
gitis. The  lungs  were  extensively  diseased. 

391.  Cartilaginous  deposits  in  the  arachnoid  membrane,  in  the  form 
of  thin,  defined  plates,  two  lines  or  more  in  diameter,  several 
of  them  having  a small  point  of  ossification  in  the  centre. 
This  appearance  was  found,  more  or  less,  throughout  the  whole 
length  of  the  spine.  The  two  other  membranes,  and  the  spinal 
marrow  itself,  are  seen  to  be  healthy.  From  a lady,  who  died 
from  cancer  of  the  breast,  having  suffered  much  from  pain  in 
the  head  and  along  the  spine.  1844. 

392.  Spinal  marrow,  from  a case  of  very  extensive  backward  cur- 
vature of  the  spine,  (No.  117.)  It  is  everywhere  of  full  size, 
except  at  the  part  which  corresponds  to  the  curvature,  and 
there,  the  investing  membrane  being  somewhat  injured  in  the 
removal,  a portion  of  its  substance  may  have  escaped  and 
caused  the  slight  appearance  of  contraction  which  is  now  seen. 

ii.  Eye. 

393.  Ossification  of  thd  eye.  The  patient  entered  the  Mass. 

14 


106 


ORGANS  OF  SENSE. 


Eye  and  Ear  Infirmary  July  6th,  1839,  and  the  following 
notes  of  the  case  were  taken  by  Dr.  E.  W.  Hooper:  — 
“ Thomas  Cummings,  aged  twenty-three,  has  had  some  incon- 
venience’ in  left  eye  from  infancy,  caused  by  a burn ; vision 
indistinct,  with  occasional,  slight  inflammation  for  many  years ; 
loss  of  vision  for  the  last  two  years,  since  which  time  he  has 
been  subject  to  violent  pain,  alternating  from  one  to  the  other 
eye,  but  seeming  to  proceed  from  the  left,  generally  one  eye 
at  a time  being  affected  with  pain,  redness,  and  flow  of  scald- 
ing tears.  Vision  of  the  right  eye  also  occasionally  much 
affected  for  the  last  two  years  ; during  this  time  has  done  no 
regular  work,  and  is  now  much  reduced  by  his  disease.  On 
examination,  the  left  eye  is  much  smaller  than  the  right ; con- 
junctiva not  injected ; cornea  transparent ; iris  dark,  and  bulges 
forward  into  the  anterior  chamber;  pupil  irregular,  and  beyond 
it  is  an  opaque  body,  of  a dirty  chalky  color,  and  adhering  to 
the  iris  at  the  upper  part;  cannot  discern  light;  no  pain. 
Eight  eye  prominent,  with  considerable  injection  of  conjunctiva ; 
cornea  transparent,  and  there  is  no  apparent  disease  within  the 
eye,  but  he  has  great  pain,  irritability  to  light,  and  flow  of 
scalding  tears. 

July  18th,  the  patient  having  got  no  relief,  the  crystalline 
lens  of  the  left  eye,  which  was  evidently  ossified,  was  removed 
by  Dr.  Jeffries,  as  being  the  source  of  the  trouble,  (No.  394) ; 
in  the  course  of  the  operation  there  was  found  to  be  in  tire 
place  of  the  vitreous  humor  a thin,  dark,  serous  fluid.  Lens 
completely  ossified,  except  in  the  centre,  where  there  was 
found  a cavity,  containing  a milky  fluid,  which  was  disclosed 
by  a portion  of  the  lens  having  been  broken  off  during  the 
operation. 

On  the  30th  of  August,  the  patient  having  continued  to 
suffer  very  severely,  and  becoming  completely  exhausted,  the 
left  eye  was  removed  by  Dr.  Jeffries,  supposing  that  some 
irritating  body  still  remained  within  it.  On  cutting  it  open, 
there  was  found  at  the  bottom  of  the  eye,  and  closely  con- 
nected with  the  choroid  coat,  an  ossific  plate,  very  irregular  in 
its  outline,  but,  by  estimate,  about  three  lures  in  diameter;  one 
sharp  point  seemed  to  be  nearly  or  quite  hr  contact  with  the 
optic  nerve  at  its  entrance  into  tire  orbit.  After  the  operation 
there  was  not  much  amendment  for  some  months,  but  hr  tire 


ORGANS  OF  SENSE. 


107 


course  of  the  following  year  the  patient  regained  his  health 
and  the  use  of  his  right  eye.”  Dr.  John  Jeffries. 

394.  Ossification  of  the  crystalline  lens.  (See  last  specimen.) 

Dr.  John  Jeffries. 

395.  Cancerous  eye,  extirpated  by  Dr.  John  Jeffries.  The  patient, 
a blacksmith,  aged  thirty-eight,  entered  the  Mass.  Eye  and 
Ear  Infirmary  August  8th,  1838,  and  reported  as  follows:  — 
The  disease  began  six  years  ago  with  a reddish,  fleshy,  but 
not  painful  tumor  near  the  inner  angle  of  the  left  eye,  and 
eighteen  months  ago  it  was  removed,  being  then  about  half  as 
large  as  a pea.  After  the  operation  the  disease  began  to 
increase,  and  during  the  last  winter  there  was  much  pain  in 
the  eye,  which  was  relieved  at  times  by  the  formation  and 
spontaneous  bursting  of  small  pustules.  Since  April  there  has 
been  an  irregular  open  surface,  with  increased  pain.  The 
ulceration  now  presents  a ragged  surface,  of  a whitish  color, 
and  attended  with  a thin,  serous  discharge ; about  the  lower 
edge  are  a few,  white,  curdy  bodies,  from  the  size  of  a small 
shot  to  that  of  a pea,  not  sensitive,  and  easily  broken  down. 
Conjunctiva  everywhere  injected.  Eye  turned  upwards  and 
outwards.  Vision  distinct  when  the  lid  is  raised  by  the  finger, 
the  organ  itself  being  apparently  healthy.  On  the  ninth  of 
August  the  eye  was  removed,  and,  at  the  end  of  a week,  the 
patient  was  discharged,  at  his  own  request. 

On  examination  of  the  organ  after  removal,  the  disease  was 
found  to  involve  the  greater  part  of  the  anterior,  free  portion 
of  the  globe  below  the  cornea.  It  seemed  to  have  originated 
in  the  sclerotic  coat,  or  in  the  cellular  membrane  connecting 
this  with  the  conjunctiva,  this  last  being  in  some  places  raised 
up  in  a healthy  state  by  the  disease  beneath  it.  Ulcerated 
surface  whitish  and  dense,  the  curdy  bodies  above  mentioned 
appearing  to  consist  of  a thickening  and  disease  of  the  sclerotic 
itself.  Lower  lid  dissected  from  the  globe  of  the  eye  to  some 
extent  by  the  ulceration.  Organ  otherwise  healthy. 

396.  Melanosis  of  the  eye.  A well  marked  melanotic  tumor,  equal 
to  more  than  an  inch  in  diameter,  is  closely  connected  with  the 
sclerotic  coat,  being  mostly  external,  though  a large  portion  is 


108 


ORGANS  OF  SENSE. 


seen  to  be  within  the  cavity ; the  structure  is  well  shown,  as 
the  mass  was  cut  through  when  the  operation  was  performed  ; 
one  or  two  quite  small  and  distinct  masses  are  also  seen,  and 
appear  to  be  just  commencing  in  the  sclerotic  coat.  The  eye 
itself  is  not  enlarged. 

The  patient,  Mrs.  P.,  aged  forty-eight,  entered  the  Eye 
Infirmary,  in  this  city,  November  12th,  1844.  Eight  years 
before,  she  began  to  have  pain  in  the  right  eye,  followed  by 
loss  of  vision,  the  pain  continuing,  and  being  so  severe  as  to 
require  the  free  use  of  opiates.  Three  years  before,  the  lens 
became  opaque,  and  for  the  last  six  months  there  had  been  a 
protrusion  of  the  eye  from  the  cavity  of  the  orbit.  On  exami- 
nation, a tumor  was  felt  just  within  the  orbit  on  the  temporal 
side  ; the  eye  was  greatly  protruded,  the  lids  discolored,  and 
the  iris  was  pushed  forward  by  the  opaque  lens.  On  the  12th, 
the  eye  was  removed  by  Dr.  R.  W.  Hooper,  and  with  it  the 
whole  of  the  diseased  mass ; the  patient  soon  became  comfort- 
able, and  on  the  23d,  returned  into  the  countiy. 

On  the  15th  of  December,  1845,  she  again  showed  herself, 
with  a return  of  the  disease ; about  a fortnight  after  she  left 
the  Infirmary,  as  she  stated,  there  appeared  a small  purplish 
spot  about  where  the  external  incision  terminated  when  the 
eye  was  removed,  and  just  in  the  cicatrix.  In  August,  the 
disease  re-appeared  in  the  orbit,  and  on  the  above  date  the 
cavity  was  filled  with  masses  varying  in  size  from  a pin’s  head 
to  a chestnut,  the  surrounding  integuments  being  also  affected ; 
at  first  there  was  severe  pain  with  swelling  in  the  cheek,  but 
these  symptoms  had  subsided,  and  her  general  health  was 
decidedly  better  than  before  the  removal  of  the  eye.  In  April, 
1847,  she  was  heard  from,  and  the  tumor  was  then  as  large  as 
a pint  bowl. 

hi.  Ear. 

397.  Various  sections  of  the  temporal  bone,  showing  the  auditory 
passages. 

398.  Ossicula  of  the  internal  ear ; foetal. 

399.  Ossicula  of  the  internal  ear ; adult, 


ORGANS  OF  SENSE. 


109 


400.  Polypus  from  the  ear  of  a female,  about  thirty  years  of  age ; 
removed  by  Dr.  John  Jeffries,  at  the  Mass.  Eye  and  Ear 
Infirmary.  It  arose  from  the  membrane  of  the  tympanum, 
was  attached  by  a very  small  pedicle,  and  gradually  enlarged 
towards  the  opposite  extremity,  so  as  to  fill  the  external 
meatus.  December,  1838. 

401.  Caries  of  the  temporal  bone.  The  patient,  a female,  aged 
eighteen,  had  had  some  discharge  from  the  ear  with  pain  for 
two  or  three  years.  For  the  last  six  weeks  the  pain  was  very 
severe,  affecting  the  whole  side  of  the  head,  with  deafness, 
and  a copious,  purulent,  and  very  fcetid  discharge ; the  general 
health  failed,  and  she  gave  up  work,  there  never  having  been 
any  active  cerebral  symptoms,  though  for  the  last  week  there 
was  a slight  pulmonary  affection.  On  dissection,  the  cavity  of 
the  tympanum  and  mastoid  cells  were  found  to  be  carious,  and 
these  last  were  filled  with  foetid  pus.  The  dura  mater  over 
the  petrous  portion  was  ash-colored,  thickened,  and  rough,  the 
bone  itself  was  much  discolored,  and  between  the  two  was  a 
collection  of  foetid  pus.  Brain  itself  sufficiently  healthy,  but 
the  lungs  were  extensively  gangrenous. 

Dr.  Charles  G.  Putnam. 

402.  Caries  of  the  temporal  bone,  from  a man  who  died  of  phthisis 
at  the  Mass.  Gen.  Hospital,  April  13th,  1838,  and  who  stated 
that  he  had  always  been  subject  to  a discharge  from  the  ear. 
The  specimen  was  examined  by  Dr.  R.  W.  Hooper,  who  found 
the  cavity  of  the  tympanum  filled  with  a very  offensive,  green- 
ish, thick  pus,  and  the  membrane  destroyed ; no  traces  of  the 
ossicula. 

403.  Caries  of  the  left  temporal  bone,  from  a young  man  who  was 
deaf  and  dumb,  and  who  died  of  phthisis  at  the  Mass.  Gen. 
Hospital,  December  27th,  1837.  The  examination  was  made 
by  Dr.  R.  W.  Hooper,  and  the  following  appearances  noted : — 
“ An  irregular  cavity  exists  in  the  substance  of  the  bone,  com- 
municating with  that  of  the  tympanum,  two  lines  in  diameter, 
and  apparently  the  result  of  caries ; both  of  these  cavities  are 
filled  with  a thick,  yellow  substance  like  melted  cheese,  and 
on  removing  this,  the  malleus  and  incus  are  detached,  the 


110 


ORGANS  OF  SENSE. 


ossicula  themselves  being  healthy ; the  membrane  of  the  tym- 
panum is  entirely  wanting.  The  vestibule,  semicircular  canals, 
and  cochlea  are  filled  with  a white,  opaque,  cheesy  substance, 
but  otherwise  appear  healthy.  Mastoid  cells  healthy.  The 
bone  has  been  sawed  through  in  various  directions,  but  the 
parts  can  be  put  together,  and  the  caries  seen.  As  to  the 
nature  of  the  disease  in  this  case,  it  was  probably,  as  in  the 
last  specimen,  a part  of  the  tuberculous  affection  of  which  the 
patient  died,  and  not  connected  with  his  deafness. 

On  cutting  through  the  inner  table  of  the  petrous  portion  of 
the  right  temporal  bone,  a transparent,  yellowish,  rather  viscid 
fluid  is  discharged  in  considerable  quantity,  seeming  to  have 
filled  the  cells.  The  different  parts  of  the  internal  ear  appear 
healthy.” 

iv.  Nose. 

404.  A fleshy  nasal  polypus,  weighing  three  ounces  and  a half ; 
the  large  bulging  extremity  protruded  into  the  throat.  The 
patient,  a middle-aged  man,  had  symptoms  of  cold  in  the  head 
in  March,  1829  ; in  May,  there  was  a considerable  discharge 
from  the  nose,  offensive,  and  sometimes  bloody.  In  June,  the 
discharge  subsided,  the  left  nostril  became  wholly  obstructed, 
and  a tumor  appeared,  which  increased  so  as  after  a while  to 
obstruct  also  the  other  nostril.  About  the  first  of  September 
the  tumor  had  increased  so  as  produce  severe  pain  in  the 
temple,  the  eye,  and  the  upper  teeth  on  the  left  side.  Septem- 
ber 19th,  he  entered  the  Mass.  Gen.  Hospital,  and  remained 
there  till  November  26th,  during  which  time  he  had  six  opera- 
tions, which  relieved  the  pain,  but  did  not  remove  the  obstruc- 
tion. In  the  spring  of  1830  the  tumor  increased,  and  frequently 
bled,  and  in  the  summer  a portion  was  twice  removed.  In 
September,  it  protruded  considerably  from  the  nostril,  and  had 
extended  backwards  so  as  to  be  seen  in  the  throat ; health 
much  impaired ; he  then  applied  to  Dr.  Walker,  who  removed 
the  tumor  by  a ligature,  having  first  cut  away  a portion  of  the 
septum  between  the  nostrils ; the  tumor  weighed  four  ounces. 
In  the  winter  of  1830  his  health  was  much  improved,  but  the 
tumor  had  reappeared  in  the  throat,  and  another  small  one  in 
the  left  cheek  ; in  May,  1831,  it  was  removed  by  ligature  from 


ORGANS  OF  SENSE. 


Ill 


the  throat.  In  May,  1832,  it  again  protruded  in  the  throat, 
and  was  again  removed  by  ligature.  In  May,  1834,  the  tumor 
filled  the  throat,  pressed  forward  the  soft  palate,  and  filled  both 
nostrils,  so  as  to  spread  the  bones  of  the  nose,  and  cause  a 
protrusion  of  the  eyes;  this  was  removed  by  ligature,  and 
weighed  three  ounces  and  a half ; the  tumor  in  the  cheek  had 
also  considerably  increased,  and  in  the  following  July  was 
removed  by  the  knife  and  ligature,  and  a seton  passed  through 
the  antrum  into  the  nostril.  After  this  last  operation  the 
patient  suffered  no  more  from  his  polypus,  but  died  a few  years 
afterwards  from  some  other  disease. 

Dr.  William  J.  Walker , of  Charlestown. 

405.  Gelatiniform,  nasal  polypi.  One  of  them  is  of  a pyriform 
shape,  and  an  inch  and  a half  in  length.  The  other,  which 
was  situated  deep  in  the  nostril,  is  of  an  oblong  form,  about  an 
inch  and  a third  in  length,  and  has  a long  pedicle,  by  which 
it  was  attached.  In  their  substance  are  several  small  vesicles. 
From  a female,  about  twenty-two  years  of  age  ; the  disease 
was  of  nearly  two  years  duration  ; the  operation  was  performed 
in  April,  1836,  with  complete  relief  for  a time,  but  the  disease 
afterwards  reappeared,  as  usual.  Dr.  J.  B.  S.  Jackson. 

v.  Skin. 

406.  Skin  of  the  fore-arm  and  hand  of  a fcetus,  minutely  injected. 

Dr.  John  Jeffries. 

407.  Portion  of  human  skin,  tanned.  From  Rog,  a pirate,  who, 
with  some  others,  was  executed  in  this  city  several  years  since. 

Dr.  S.  D.  Townsend. 

408.  Portion  of  human  skin,  tanned.  From  Walton,  the  highway- 
man, who  died  at  the  State  Prison  hr  1837. 

Dr.  Winsloio  Lewis. 

409.  Specimens  of  skin  pricked  with  India-ink. 

Dr.  Charles  H.  Stedman. 


410.  The  same. 


Dr.  J.  B.  S , Jackson. 


112 


ORGANS  OF  SENSE. 


411.  The  skin  and  nail  of  the  little  finger,  preserved  in  spirit;  from 
a lad,  thirteen  years  of  age,  who,  jumping  up  to  reach  some- 
thing from  a hook,  got  the  hook  caught  in  a ring  which  he  had 
upon  the  finger,  and  tore  the  skin  and  nail  entirely  off;  the 
accident  happened  four  years  ago,  and  the  young  man  has 
now  a serviceable  finger,  and  upon  it  a rudimentary  nail.  The 
ring  accompanies  the  specimen.  1845. 

Dr.  William  E.  Coale. 

412.  Cutaneous  excrescences  from  tanned  South  American  Ox- 

hides ; they  are  mostly  from  two  to  four  inches  in  length,  and  more 
than  an  inch  in  diameter,  and  were  all  of  them,  four  in  number, 
cut  from  about  the  neck.  1842.  Dr.  A.  A.  Gould. 

413.  Wax  model  of  an  upper  extremity  affected  with  Lepra. 
This  and  the  following  are  French  preparations.  1840. 

Dr.  George  C.  Shattuck,  Jr. 

414.  Wax  model  of  a leg  affected  with  Psoriasis.  1840. 

Dr.  George  C.  Shattuck , Jr. 

415.  Cast  in  plaster  of  a lower  extremity  affected  with  Elephantiasis ; 
taken  by  an  Italian  artist  in  this  city,  and  presented  to  the 
Society  by  Dr.  George  Hayward.  The  whole  limb  was  en- 
larged, and  particularly  the  lower  part  of  the  leg,  which 
measured  twenty-eight  inches  in  circumference,  the  limb  con- 
tracting to  its  natural  dimensions  just  above  the  ancle,  and 
very  suddenly;  foot  not  affected.  The  integuments  of  the 
thigh  and  leg  were  coarse,  hard,  and  unyielding,  becoming 
more  so  below  the  knee,  the  most  diseased  part  being  cracked, 
rough,  and  tuberculated  on  the  surface ; on  this  last  were  also 
extensive  and  hard  crusts,  from  an  abundant  serous  exudation, 
to  which  the  patient  had  been  subject  for  about  two  years. 
The  whole  limb  was  colder  by  several  degrees  than  natural, 
and  of  a darker  hue. 

The  patient,  aged  twenty-one,  was  a Virginian  by  birth,  but 
had  lived  in  this  state  since  he  was  two  years  of  age.  In 
February,  1842,  he  entered  the  Mass.  Gen.  Hospital  to  have 
the  limb  removed,  but  nothing  was  done,  and  he  soon  left  the 
house.  The  disease  was  of  sixteen  years  duration,  and  began 


ORGANS  OF  SENSE. 


113 


with  swelling  and  a shooting  pain  in  the  limb,  coming  on  after 
a slight  injury,  which  was  attended  with  general  febrile  symp- 
toms, and  confined  him  to  the  house  for  two  months.  The 
swelling  increased  very  slowly,  and  he  had  occasional  attacks 
resembling  fever  and  ague,  accompanied  by  severe  shooting 
pain  in  the  left  groin  and  limb.  Eight  years  before  admission 
he  went  to  sea,  and  for  the  next  six  years  he  was  able  to  per- 
form all  the  duties  of  a seaman  without  inconvenience ; the 
swelling  and  pain  in  the  limb  then  increased  more  rapidly,  and 
the  skin,  which  had  been  smooth,  became  rough,  tuberculated, 
and  cracked,  with  serous  discharge,  as  above  stated ; this,  of 
course,  obliged  him  to  give  up  his  work,  though  his  general 
health  was  sufficiently  good. 

The  patient  is  now  (1845)  at  Lowell,  and  the  size  of  the 
limb  has  greatly  increased. 

416.  A very  beautiful  pencil-drawing  of  a foot  and  leg  affected 
with  Elephantiasis.  The  specimen,  which  has  not  been  pre- 
served, was  sent  to  the  Society  from  St.  Croix,  by  Dr.  William  E. 
Townsend,  whilst  on  a visit  to  that  Island  for  his  health.  The 
patient  was  a middle-aged  man,  veiy  intemperate  in  his  habits, 
and  had  had  the  disease  for  many  years ; the  limb  was  ampu- 
tated below  the  knee.  1841.  Dr.  J.  Francis  Tuckerman. 

417.  Two  specimens  of  cuticle  from  a fcetus  at  the  term,  showing 

its  different  thickness  in  different  parts  of  the  body;  the 
thickest  specimen  is  from  the  heel,  and  the  other  from  about 
the  knee.  Dr.  J.  B.  S.  Jackson . 

418.  “ A Cornu,  being  a preternatural  growth  from  the  nail  of  the 
Right  great  toe  of  a woman,  ninety-two  years  of  age,  which 
turned  under  the  ball  of  the  foot ; taken  from  a patient  by  Dr. 
Jeffries.  Anno  1798.”  From  his  son.  Dr.  John  Jeffries. 

419.  Hypertrophy  of  the  great  toe  nails,  from  a middle-aged  female  ; 
one  measured  twenty-three,  and  the  other  thirty-two  lines  in 
length ; they  are  hard,  thickened,  strongly  incurvated,  and  are 
preserved  in  connection  with  the  last  phalanx.  1841. 

Dr.  O.  W.  Holmes, 


15 


114 


VOCAL  AND  RESPIRATORY  ORGANS. 


420.  Case  of  nsevus  upon  the  scalp.  The  subject  was  an  infant, 
aged  ten  months  ; the  complexion  was  very  fair,  and  the  head 
covered  with  long,  soft,  and  perfectly  white  hair,  except  over 
one  parietal  bone,  where  was  a single  lock  of  hair,  which,  by 
contrast,  appeared  to  be  nearly  black.  At  the  time  of  birth 
there  was  in  the  place  of  this  last  a patch  of  coarse,  dark 
colored  skin,  but  no  hair.  Two  locks  are  shown  beneath  a 
plate  of  glass,  and  the  contrast  of  color  is  very  striking.  1847. 

Dr.  J.  B.  S.  Jackson. 

421.  Hair  from  the  head  of  an  Albino  negro  boy;  it  is  perfectly 
crisped,  but  snow-white,  as  were  the  eye-lashes  and  eye-brows, 
the  colored  part  of  the  eyes  being  pink,  and  the  complexion 
delicately  fair.  His  voice,  however,  was  coarse,  and  his 
features  those  of  a full  blooded  negro.  He  was  exhibited  in 
this  city  in  July,  1841  ; according  to  his  keeper,  he  was  eight 
years  of  age,  and  came  from  the  State  of  Georgia ; his  parents 
are  native  Africans,  perfectly  black,  and  have  four  or  five 
other  children,  who  are  not  remarkable  as  to  color. 

Dr.  J.  B.  S.  Jackson. 


VI.  VOCAL  AND  RESPIRATORY  ORGANS, 
i.  Air  Passages. 

422.  Complete  ossification  of  the  thyroid  and  cricoid  cartilages. 

1832.  Dr.  J.  B.  S.  Jackson. 

423.  Ossification  of  the  arytenoid  cartilage ; several  specimens. 
M.  Andral,  (Anat.  Path.)  MM.  Trousseau  and  Belloc,  (Phthisis 
Lar.)  Dr.  Gross,  (Path.  Anat.)  and  Dr.  Ryland  (Dis.  of  the 
Larynx)  give  the  impression,  or  state,  that  this  has  never  been 
observed,  and  yet,  I think  that  I have  met  with  it  as  often  in 
this  as  in  any  of  the  other  cartilages.  1832. 

Dr.  J.  B.  S.  Jackson. 


VOCAL  AND  RESPIRATORY  ORGANS. 


115 


424.  Ossification  of  the  trachea,  from  a man  eighty-four  years  of 

age.  Dr.  J.  B.  S.  Jackson. 

425.  Ossification  of  the  trachea  and  larynx ; prepared  in  connec- 
tion. 1843.  Dr.  J.  B.  S.  Jackson. 

426.  Ossification  of  the  trachea  of  a Peacock ; in  birds  this  may 
perhaps  be  considered  as  the  normal  condition.  1843. 

Dr.  J.  B.  S.  Jackson. 

427.  Caries  of  the  upper  back  part  of  an  ossified  cricoid  cartilage. 
From  a middle  aged  man,  who  died  of  phthisis.  The  speci- 
men of  necrosis  of  the  sternum  (No.  147)  was  from  the  same 
subject.  June,  1844. 

428.  The  larynx  of  a man  who  had  cut  his  throat  three  different 
times,  a patient  of  Dr.  Benjamin  E.  Cotting,  of  Roxbury. 
The  cicatrization  upon  the  inner  surface,  the  result  of  one  of 
his  former  attempts,  is  very  distinctly  seen,  and  a piece  of 
whale-bone  has  been  passed  through,  to  show  a fistulous  opening 
which  remains.  The  thyroid  and  cricoid  cartilages  are  exten- 
sively ossified,  and  upon  the  left  side  are  firmly  anchylosed, 
but  this  is  perhaps  a mere  coincidence  in  the  case.  The 
cricoid  had  been  cut  through  on  the  median  line  anteriorly,  at 
some  former  time,  and  the  two  extremities,  instead  of  being  in 
apposition,  are  situated  the  one  directly  above  the  other,  and 
about  one-third  of  an  inch  apart.  In  the  preparation,  the 
larynx  has  been  cut  open  posteriorly,  and  the  thyroid  cartilage 
removed  upon  the  right  side,  so  that  all  the  above  points  are 
distinctly  shown. 

The  patient  was  seventy-four  years  of  age,  and  a pauper  in 
the  Roxbury  Alms-house  ; habits  very  intemperate.  In  June, 
1841,  he  cut  his  throat  for  the  first  time,  and  recovered  with  a 
fistula,  one-third  of  an  inch  in  diameter,  and  about  in  the  situa- 
tion of  the  cricoid  cartilage.  The  second  attempt  was  made 
on  the  26th  of  December,  1843,  and  he  was  then  first  seen 
by  Dr.  C. ; he  had  severed  about  four-fifths  of  the  wind-pipe, 
through  the  old  fistula,  and  had  divided  a large  vein  upon  the 
right  side ; lacerated  by  three  or  four  strokes  of  a razor,  and 
bled  profusely.  Sutures  were  taken  in  the  skin,  and  one 


116 


VOCAL  AND  RESPIRATORY  ORGANS. 


through  the  wind-pipe  itself,  an  opening  being  left  in  front  to 
prevent  suffocation,  and  the  wound  healed  by  granulation  in 
about  four  weeks,  leaving  a fistula  about  five-eighths  of  an 
inch  in  diameter.  On  the  16th  of  April,  1844,  an  operation 
was  performed  to  close  this  opening,  and  on  the  eighth  of  May 
a second,  after  which  the  closure  was  such  that,  as  seen  in  the 
preparation,  a small  probe  only  would  pass  through : his 
speech,  &c.  were  restored,  and  no  air  could  be  forced  through. 
On  the  28th  of  May,  1844,  he  cut  his  throat  for  the  third  time, 
and  died  in  about  ten  minutes,  lacerating  the  soft  parts  exten- 
sively, but  not  dividing  the  larynx  nor  the  trachea. 

429.  Ossified  cyst  from  the  thyroid  gland,  about  the  size  of  a pea. 

1844.  Dr.  J.  B.  S.  Jackson. 

430.  Larynx  and  trachea  from  a case  of  croup,  preceded,  as  so 
often  happens,  by  an  effusion  of  lymph  in  the  fauces.  From  a 
child,  three  years  of  age,  a patient  of  Dr.  John  H.  Dix. 
April  20th,  he  went  to  school,  and,  as  it  was  thought,  took  cold  ; 
on  the  22d,  Dr.  D.  saw  him,  and  found  redness  of  the  fauces 
and  right  tonsil;  on  the  24th,  the  left  tonsil  was  inflamed,  and 
lymph  had  begun  to  appear.  Symptoms  of  croup  supervened 
on  the  26th,  probably  late  in  the  day,  and  the  child  died  about 
eleven  o’clock,  P.  M.  On  the  27th,  breathing  very  difficult 
and  hoarse  ; spoke  in  a loud  whisper ; cough  hoarse  ; much 
dysphagia. 

On  dissection,  lymph  was  found  on  both  of  the  tonsils,  and 
upon  the  root  of  the  tongue,  besides  some  upon  the  soft  palate ; 
tonsils  considerably  enlarged.  Larynx  and  under  surface  of 
epiglottis  coated  with  adherent  lymph,  the  ventricles  being  filled 
with  it ; extended  about  half  way  down  the  trachea,  becoming 
gradually  very  much  softer  and  less  adherent,  and  being  finally 
lost  in  the  viscid  secretion  which  nearly  filled  the  canal ; on 
the  right  side,  however,  it  was  continued  down  to  about  the 
commencement  of  the  secondary  bronchi.  The  bronchi  con- 
tained a great  quantity  of  yellowish,  creamy  pus,  but  without 
any  appearance  of  lymph  or  mucus.  Mucous  membrane 
somewhat  red,  the  lungs  being  only  moderately  congested. 
Peyer’s  patches  somewhat  red,  as  they  not  very  unfrequently 
are  in  this  and  in  some  other  cases  of  acute  disease  in  children. 


VOCAL  AND  RESPIRATORY  ORGANS. 


117 


431.  Several  pieces  of  membrane  expectorated  in  a case  of  croup, 

two  of  them  being  about  two  inches  in  length.  The  patient 
was  a little  boy,  seven  years  of  age,  and  had  had  symptoms  of  the 
disease  for  eight  days.  On  dissection,  the  usual  appearances 
were  found,  the  membrane  extending  far  down  into  the  bronchi ; 
in  the  trachea,  it  was  evident  that  the  original  membrane  had 
been  thrown  off,  and  a new  one  formed  in  its  place.  A few 
days  afterwards  a second  fatal  case  occurred  in  the  same 
family.  1844.  Dr.  John  Homans. 

432.  “ Bronchial  polypus  a portion  of  lymph  expectorated,  during 

a severe  attack  of  pneumonia,  by  a gentleman,  aged  sixty-one. 
It  is  about  two  inches  in  length,  firmer  than  the  membrane  in 
croup,  and  appears,  from  its  ramifications,  to  have  been  formed 
in  the  smaller  bronchi.  1835.  Dr.  James  Jackson. 

433.  Very  extensive  chronic  ulceration  of  the  throat,  from  a patient 
of  Dr.  Charles  T.  Hildreth.  The  soft  palate  and  epiglottis  are 
entirely  destroyed,  with  extensive  and  deep  ulceration  of  the 
tonsils,  and  across  the  root  of  the  tongue ; the  right  horn  of 
the  os  hyoides  is  completely  exposed  to  the  extent  of  about 
half  an  inch,  and  also  the  upper  part  of  the  thyroid  cartilage  ; 
glottis  extensively  ulcerated  ; vocal  cords  about  half  destroyed 
on  the  right  side,  but  less  so  on  the  left.  The  general  char- 
acter of  the  ulceration  is  not  remarkable,  and  there  is  no  exten- 
sion of  disease  down  the  oesophagus.  From  a little  girl,  aged 
fourteen.  Symptoms  of  disease  in  throat  since  she  was  five 
years  old ; for  the  last  one  or  two  years  there  had  been 
aphonia,  with  excessive  dysphagia,  her  food  often  getting  into 
the  larynx,  causing  a suffocating  cough,  and  being  thrown  back 
into  the  nostrils  ; she  was  also  deaf.  Several  years  before 
death  the  nose  was  destroyed  by  the  disease,  and  a syphilitic 
taint  was  of  course  suspected,  but,  except  for  the  facts  just 
mentioned,  there  were  no  indications  of  this  disease  ; it  was 
rather  thought  to  be  a “ scrofulous  affection,”  but  neither  in  the 
lungs  nor  in  the  glands  were  there  any  traces  of  tubercular 
deposit.  The  father  was  intemperate,  but  healthy,  as  was  the 
mother,  except  for  disease  of  the  heart,  of  which  they  both 
died.  1834. 


118 


VOCAL  AND  RESPIRATORY  ORGANS. 


434.  Extensive  and  deep  ulceration  on  each  side  of  the  larynx,  in 
the  situation  of  the  arytenoid  cartilages.  On  the  left  side 
the  cartilage  is  about  one-half  denuded,  and  on  the  right  no 
trace  of  it  is  to  be  found.  Right  vocal  cord  partially  destroyed. 
From  a man,  aged  thirty-three,  a patient  of  Dr.  Woodbridge 
Strong,  who  died  of  very  extensive  tubercular  disease  of  the 
lungs  of  two  years  duration.  Voice  affected  for  six  months, 
and  aphonia  for  the  last  two  ; much  troubled  by  regurgitation 
of  liquids  for  three  months.  On  the  day  before  his  death  he 
expectorated  a substance,  which,  though  not  strictly  examined, 
was  probably  the  right  arytenoid  cartilage.  1832. 

435.  Portions  of  bone  expectorated,  probably  exfoliations  from  the 
os  hyoides ; the  largest,  which  seems  to  have  been  a part  of 
the  body  of  the  bone,  is  ten  lines  in  length,  following  the 
curve,  two  in  width,  and  about  one  in  thickness ; the  other 
fragments  are  quite  small.  From  a man,  about  thirty-six  years 
of  age.  The  symptoms  were  hoarseness,  a husky,  laryngeal 
cough,  pain,  swelling,  and  tenderness  about  top  of  larynx,  and 
in  the  right  side  of  larynx  a rough,  flapping  sound  heard  on 
coughing  and  speaking ; pieces  of  bone  were  thrown  off  three 
different  times  within  six  weeks,  and  once  the  fragments  were 
larger  than  those  which  have  been  preserved.  The  above 
symptoms  lasted  about  five  or  six  months ; the  cough,  however, 
remained  for  some  time  after  the  man  returned  to  his  work, 
and  considered  himself  as  well.  1837.  Dr.  John  Ware. 

436.  The  stopper  of  a Wedgewood  ink-stand,  which  remained  in 
the  air  passages  for  eight  months,  and  was  at  last  thrown  ofT 
by  coughing ; length  eight  lines,  and  greatest  width  five. 

The  patient  was  a healthy  little  girl,  aged  eleven  years. 
The  accident  happened  about  the  first  of  September,  1835; 
there  was  a momentary  sense  of  suffocation,  hut  no  other 
suffering  at  the  time,  and  it  was  supposed  the  foreign  body  en- 
tered the  stomach.  For  some  days  there  was  a slight  disposition 
to  cough,  with  other  symptoms,  which  seemed  to  indicate  a 
disordered  stomach,  and  which  were  relieved  by  an  emetico- 
cathartic,  and  about  the  first  of  October,  there  was  a return  of 
these  symptoms  for  three  or  four  days.  Towards  the  last  of 
October  she  had  what  appeared  to  be  typhoid  fever,  with  con- 


VOCAL  AND  RESPIRATORY  ORGANS. 


119 


siderable  thoracic  affection ; the  fever  left  her  in  two  or  three 
weeks,  but  the  cough  increased,  and  was  attended  by  a copious 
muco-purulent  expectoration,  the  physical  signs  indicating  no 
other  affection  than  that  of  the  mucous  membrane ; was  not 
confined  to  the  room  by  the  cough,  nor  entirely  to  the  house. 

On  the  22d  of  February,  she  was  suddenly  seized  with  suf- 
focation after  a violent  fit  of  coughing.  At  the  beginning  of 
each  paroxysm  the  cough  was  accompanied  by  a sound  in  the 
trachea,  as  of  the  closing  of  a valve,  which  was  loud  enough 
to  be  distinctly  heard  across  the  room  ; then  followed  a sus- 
pension of  breathing  for  a time,  and  then  a copious  expectora- 
tion of  purulent  mucus  with  partial  relief,  until  another  fit  of 
coughing  renewed  the  distress.  The  presence  of  a foreign 
body  in  the  air-passages  had  been  suspected  from  the  first,  but 
was  now  certain,  and  an  operation  was  decided  upon,  but 
before  the  arrangements  could  be  made  the  patient  was  so 
much  enfeebled  as  to  render  the  attempt  apparently  hopeless. 
For  three  or  four  days  she  was  in  a state  of  great  exhaustion ; 
pulse  140  to  160;  unable  to  breathe  except  in  the  erect  posture, 
and  subject  to  frequent  paroxysms  of  cough  and  distress,  with 
copious  expectoration,  as  before  ; these  last,  however,  became 
less  frequent,  and  her  strength  improved. 

On  the  2d  of  March,  the  operation  of  tracheotomy  was  per- 
formed by  Dr.  J.  C.  Warren,  and  the  passage  was  kept  open 
for  about  a fortnight,  but  without  any  effect,  as,  whenever  the 
opening  was  free,  the  cough  ceased.  Meanwhile  her  health 
constantly  improved,  and  the  paroxysms  became  less  frequent 
and  distressing ; she  became  able  to  ride  and  walk  out,  but 
was  subject  to  dyspnoea  on  quick  motion. 

On  the  2d  of  May,  about  eight  months  from  the  time  of  the 
accident,  the  foreign  body  was  thrown  off  during  a slight  fit  of 
coughing,  without  violence  or  distress,  and  from  this  time  the 
patient  soon  recovered  her  health.  Dr.  Enoch  Hale. 

437.  The  seed  of  a Water-melon,  which  was  swallowed,  causing 
symptoms  of  chronic  laryngitis,  and  at  the  end  of  four  months 
was  expelled,  with  recovery.  The  patient,  a little  boy,  five 
years  of  age,  came  in  from  the  garden,  where  he  had  been 
playing,  with  croup,  as  the  mother  supposed ; she  thought  that 
he  had  taken  cold,  and  that  the  disease  had  thus  suddenly 


120 


VOCAL  AND  RESPIRATORY  ORGANS. 


supervened.  The  symptoms  were  such  that  for  some  time  it 
was  regarded  as  that  disease,  and  treated  accordingly  by  the 
physician  in  attendance.  After  a while,  finding  that  there  was 
no  material  change,  Dr.  P.  was  called  in,  and  had  charge  of  the 
case  from  that  time.  The  voice  was  very  hoarse  and  shrill ; 
cough  not  urgent,  but  frequent,  and  strongly  laryngeal,  the 
expectoration  being  very  slight ; respiration  slow,  noisy,  very 
laborious,  and  evidently  showed  some  great  obstruction  about 
the  larynx,  such  that,  from  the  time  of  the  accident,  the  child 
was  never  able  to  lie  down  in  bed,  and  was  often  thought  by 
its  parents  to  be  dying ; there  was  tenderness  on  pressure  about 
the  larynx,  with  enlargement  of  the  neighboring  glands. 
Meanwhile,  the  general  health  became  affected,  and  the  child 
was  fast  passing  into  a state  of  marasmus,  when,  at  the  end  of 
four  months  from  the  time  of  the  accident,  the  presence  of  a 
foreign  body  never  having  been  suspected,  the  seed  was  sud- 
denly expelled  during  a fit  of  coughing,  and  the  child  immedi- 
ately began  to  recover.  The  case  occurred  in  the  sum- 
mer of  1844.  With  regard  to  the  situation  of  the  foreign 
body  in  this  case,  there  may  be  a question  whether  it  was 
within  or  just  without  the  cavity  of  the  larynx,  the  ventricles, 
in  which  alone  it  could  have  been  arrested,  if  within,  being 
very  small  in  a child  of  this  age.  Dr.  M.  S.  Perry. 

n.  Lungs. 

438.  Pulmonary  emphysema,  with  thin  sections  of  the  same ; a 
dried  specimen,  and  preserved  in  a glass  jar. 

439.  Pulmonary  apoplexy.  A thin  section  of  the  lung  having 

been  dried,  the  limits  between  the  dark  coagulum  and  the 
simply  congested  tissue  are  very  distinct.  From  a man  who 
died  at  the  Mass.  Gen.  Hospital,  June  17th,  1836,  from  the 
rupture  of  a large  aneurism  of  the  abdominal  aorta  into  the 
right  lung.  Dr.  Jeffries  Wyman. 

440.  Spurious  melanosis  of  the  lung,  from  about  the  left  apex ; 
when  recent,  it  was  nearly  coal-black,  and  uniformly  so ; felt 
as  if  it  contained  tubercles,  though  none  could  be  distinguished. 
According  to  Dr.  E.,  nearly  the  whole  of  the  left  lung  was  in 


VOCAL  AND  RESPIRATORY  ORGANS. 


121 


the  same  state,  and  about  midway  posteriorly  there  was  a small 
abscess,  which  was  filled  with  pus.  On  the  right  side,  the 
middle  lobe  was  similarly  affected,  a portion  of  which  has 
been  preserved ; discoloration  very  much  scattered  through  the 
lower  lobe,  and  in  the  upper  was  found  a cavity  as  large  as 
the  fist.  No  black  matter  in  any  other  organs.  From  a man, 
about  forty  years  of  age,  who  died  at  the  House  of  Industry  in 
August,  1838,  apparently  of  phthisis ; the  expectoration  was 
generally  characteristic  of  this  disease,  but  for  two  months 
after  his  entrance  it  was  unusually  dark. 

Dr.  William  Eustis. 

441.  Upper  lobe  of  the  left  lung  in  the  third  stage  of  pneumonia, 
and  exhibiting  a large  gangrenous  cavity.  From  a man,  forty 
years  of  age,  who  entered  the  Mass.  Gen.  Hospital  January 
12th,  1837,  and  died  on  the  29th.  Habits  quite  intemperate ; 
had  been  subject  to  fits  of  some  sort  for  about  three  months, 
and  had  also  been  insane  from  about  the  first  of  November  till 
the  latter  part  of  December.  On  admission,  having  just  come 
from  the  McLean  Asylum,  there  was  reported  cough  with  pain 
in  the  chest  for  the  last  three  weeks,  and  a frothy,  greenish 
expectoration ; was  pale,  quite  tremulous,  and  complained  of 
weakness;  skin  natural;  pulse  88;  appetite  good.  From  the 
above  date  till  his  death  there  was  much  cough  most  of  the 
time;  expectoration  from  § ss.  to  § i. , generally  yellowish  or 
greenish,  with  some  mixture  of  purulent  mucus,  but  on  the 
last  day  dark  brown  and  foetid;  breath  reported  uniformly, 
after  the  15th,  as  having  a foetid,  and  sometimes  a gangrenous 
odor,  and  on  the  27th,  the  foetor  extended  over  the  ward.  On 
the  14th,  the  respiration  was  reported  vesicular  under  both 
clavicles,  with  some  sonorous  rale,  the  resonance  being  pretty 
good;  on  the  21st,  signs  of  disease  began  to  appear,  and 
before  death  there  was  cavernous  respiration,  with  gurgling 
and  flatness  on  percussion  over  the  front  of  the  left  lung ; on 
the  last  day,  however,  there  was  resonance  within  an  inch  of 
the  sternum. 

On  examination  after  death,  a gangrenous  cavity  was  found 
about  the  middle  of  the  upper  left  lobe,  capable  of  holding 
§iv.  or  more,  traversed  by  the  soft  shreddy  remains  of  the 
pulmonary  tissue,  of  a dark  brownish  color,  and  containing  a 
16 


122 


VOCAL  AND  RESPIRATORY  ORGANS. 


very  thick,  dark,  bloody  fluid,  the  whole  having  an  excessively 
foetid  odor;  the  rest  of  this  lobe  was  in  the  state  of  grey 
hepatization,  except  the  anterior  portion,  where  was  a cavity 
containing  one  or  two  ounces  of  thick  pus,  and  very  near  to  a 
state  of  gangrene.  In  the  lower  lobe  were  numerous  deposits 
of  opaque,  yellowish  lymph,  two  or  three  lines  in  diameter, 
the  intervening  pulmonary  tissue  being  somewhat  oedematous. 
The  pleura  of  this  side  was  covered  with  recent  lymph,  with 
adhesions  above,  and  serous  effusion  below.  The  pleura  and 
the  lymph  upon  it,  to  the  extent  of  three  or  four  inches,  were 
quite  dark,  as  if  tending  to  sphacelus ; in  the  pectoral  muscles 
were  several  spots  of  a dull  brownish  and  greenish  color,  and 
having  a gangrenous  odor,  though  not  softened,  and  upon  the 
surface  of  the  body,  before  the  examination,  there  was  noticed 
a bluish  discoloration  between  the  third  and  fourth  ribs  on  the 
left  side;  this  was  probably,  however,  a cadaveric  change, 
though  the  examination  was  made  but  seventeen  hours  after 
death.  Right  lung  healthy,  except  for  some  pneumonia. 

442.  A tubercular  cavity  in  the  apex  of  the  left  lung  about  the  size 
of  an  English  walnut,  filled,  when  recent,  with  a bluish,  pasty 
substance,  and  showing  every  mark  of  an  arrest  of  the  disease. 
Somewhat  similar  cavities  were  found  in  the  right  apex,  and  in 
both  upper  lobes  were  a few  perfectly  latent  tubercles.  From 
a gentleman,  fifty-eight  years  of  age ; he  had  the  general 
appearance  of  one  who  enjoyed  fine  health,  and  was  for  many 
years  engaged  actively  in  professional  business.  Twenty- two 
years  before  his  death  he  had  active  hsemoptisis,  which  occurred 
several  times  during  the  two  following  years,  with  cough,  dys- 
pnoea, and  pain  in  the  chest,  so  that  he  was  thought  by  all  his 
friends  to  have  phthisis.  From  that  time  he  changed  entirely 
his  habits,  adopting  a system  of  more  active  exercise,  living  for 
a long  time  on  milk  and  vegetable  food,  and  ever  afterwards 
abstaining  from  wine.  For  many  years  after  this  he  enjoyed 
very  tolerable  health,  but  continued  to  have  a loud,  sonorous 
cough,  which  was  perhaps  aggravated  by  a free  use  of  snuff. 
Five  or  six  years  before  death  he  had  another  copious  hsemop- 
tisis, after  having  suffered  from  prolonged  cough,  pain  in  the  left 
hvpochondrium,  and  a derangement  of  the  stomach  and 
bowels ; for  three  months  he  was  mostly  confined  to  the  house, 


VOCAL  AND  RESPIRATORY  ORGANS. 


123 


and  for  about  a year  his  health  continued  very  delicate,  when 
it  was  again  restored,  and  he  continued  as  well  as  usual  till  he 
was  attacked  with  acute  pneumonia,  which  proved  fatal  in  from 
two  to  three  weeks.  1834.  Dr.  James  Jackson. 

443.  Pneumo-thorax.  The  specimen  shows  a tuberculous  cavity, 
which,  when  recent,  was  rather  more  than  an  inch  in  diameter, 
and  situated  in  the  upper  and  posterior  part  of  the  lower  lobe 
of  the  left  lung,  the  perforation  being  very  minute,  but  now 
somewhat  enlarged ; a large  bronchus  is  seen  opening  into  it. 
This  lung  was  collapsed,  and  contained  only  a very  few  tuber- 
cles ; the  pleural  cavity  contained  nearly  five  and  a half  pints 
of  pus  and  lymph,  besides  a considerable  quantity  of  air,  the 
membrane  being  covered  with  a thick  false  membrane.  Right 
lung  decidedly  more  tuberculous  than  the  left,  though  not  very 
extensively  so ; M.  Louis  seems  to  connect  the  greater  fre- 
quency of  perforation  on  the  left  side  with  the  greater  tendency 
of  that  lung  to  tuberculous  disease,  but  this  does  not  accord 
with  the  observations  which  have  been  made  here. 

From  a sailor,  aged  forty-four,  who  died  at  the  Mass.  Gen. 
Hospital  June  18th,  1838,  having  had  symptoms  of  phthisis  for 
six  months.  Perforation  took  place  nineteen  days  before  death ; 
dyspnoea  urgent,  with  copious  perspiration  ; amphoric  respira- 
tion, metallic  tinkling,  and  resonance  on  percussion  below  the 
left  scapula,  the  resonance  of  the  left  chest  depending  much 
upon  the  position  of  the  patient;  on  succussion,  the  sound  of 
fluid  was  heard,  at  some  distance  from  the  chest,  and  on  one  day 
a metallic  ringing  sound  was  perceived  by  the  ear,  if  applied 
to  the  sternum  when  the  back  wras  percussed. 

444.  Pneumo-thorax.  The  patient,  a middle-aged  man,  had  had 
symptoms  of  phthisis  for  about  eighteen  months,  and  the  perfo- 
ration occurred  forty-one  days  before  death.  The  symptoms 
of  this  last  were  as  follows : lancinating  pain  in  and  below  the 
left  hypochondrium  the  first  three  days,  relieved  on  the  fifth, 
and  none  for  the  last  three  weeks,  though  there  was  a constant 
complaint  of  severe  distress  about  the  middle  of  the  sternum ; 
urgent  dyspnoea  throughout,  the  cough  becoming  dry ; respira- 
tions from  30  to  36 ; pulse  from  92  to  130,  but  generally  about 
100.  The  physical  signs  of  perforation  were,  most  of  them, 


124 


VOCAL  AND  RESPIRATORY  ORGANS. 


strongly  marked  from  the  first;  amphoric  respiration  below  left 
scapula,  and  metallic  tinkle  on  swallowing,  coughing,  or  speak- 
ing, but  not  on  inspiration  ; respiratory  murmur  absent  on  left 
side,  puerile  on  right ; pulsation  of  heart  on  right  of  median 
line. 

On  dissection,  the  left  side  of  the  chest  was  found  much 
enlarged,  and,  on  succussion,  the  motion  of  fluid  was  very  per- 
ceptible ; resonant  towards  sternum,  but  flat  elsewhere,  there 
being  a free  escape  of  air  on  puncturing  this  side,  and  the 
cavity  containing,  by  measurement,  a gallon  of  pus,  besides  a 
considerable  quantity  of  lymph.  The  diaphragm  was  pushed 
down  so  as  to  be  convex  towards  the  abdomen,  the  spleen  was 
found  entirely  below  the  hypochondrium,  the  stomach  within 
two  and  a half  inches  of  the  pubes,  and  the  heart  in  the  right 
side  of  the  chest.  The  perforation  was  in  the  upper  back  part 
of  the  lower  lobe,  two  lines  or  more  in  diameter,  and  commu- 
nicated with  a cavity  just  below  the  surface  of  the  lung,  about 
one-third  of  an  inch  in  diameter,  and  into  which  a bronchus 
opened  freely ; these  last  points  are  all  shown  in  the  portion  of 
lung  which  has  been  preserved.  The  left  lung  was  collapsed, 
and  contained  but  few  tubercles,  though  there  was  a second 
abscess,  about  the  size  of  a nutmeg,  below  the  first.  The 
right  lung  was  large,  and  contained  a few  tubercles  at  the 
apex.  1841. 

This  patient  was  attended  by  the  late  Dr.  Charles  T.  Hildreth, 
and  the  case  is  interesting  as  having  been  the  first  in  which  he 
observed  the  production  of  a metallic  tinkle  during  the  act  of 
swallowing,  an  original  observation,  and  one  which  was  con- 
firmed by  subsequent  experience  in  his  own  practice,  and  in 
that  of  others  in  this  city. 

445.  Haemorrhage  from  the  bursting  of  the  pulmonary  artery  into 
a tuberculous  cavity,  from  a patient  of  Dr.  He  nr}'  I.  Bowditch. 
A portion  of  the  right  upper  lobe  is  seen,  containing  a large 
cavity,  which,  when  recent,  was  filled  with  blood,  as  were  the 
air-passages  generally,  and  in  which  last  the  coagula  are  still 
seen.  A large  blood-vessel  is  also  distinctly  seen,  and  a fibri- 
nous mass  closing  its  opening  into  the  cavity;  this  was  proved 
to  be  a branch  of  the  pulmonary  artery,  and  was  undoubtedly 
the  source  of  the  haemorrhage. 


VOCAL  AND  RESPIRATORY  ORGANS. 


125 


From  a man,  twenty-three  years  of  age;  pulmonary  symp- 
toms for  two  or  three  years  before  death,  and  in  the  summer 
of  1839  phthisis  became  fully  developed.  October  21st,  the 
patient  having  been  unusually  well  through  the  day,  walked  up 
two  pairs  of  stairs,  sat  down  upon  the  bed,  and  was  suddenly 
seized  with  a spouting  of  blood  from  his  mouth  to  the  amount 
of  several  pints;  under  the  use  of  the  acetate  of  lead  the 
haemorrhage  ceased,  but,  on  the  evening  of  the  23d,  it  recurred 
with  violence,  and  for  a time  he  seemed  to  be  moribund;  he 
however  rallied,  but  was  on  the  whole  failing,  when,  during 
the  night  of  the  25th,  he  raised  about  a gill  of  blood,  and  died 
instantly. 

* 

hi.  Bronchial  Glands. 

446.  Ossification  of  the  bronchial  glands,  from  various  subjects. 

Dr.  J.  B.  S.  Jackson. 

447.  A cavity  at  the  root  of  the  trachea,  opening  into  the  oesoph- 
agus. From  a little  girl,  seven  years  of  age,  a patient  of  the 
late  Dr.  Charles  T.  Hildreth.  Symptoms  of  phthisis  had 
existed  for  about  five  months ; there  had  also  been  pain  in  the 
region  of  the  cavity,  and  for  the  last  three  or  four  weeks  a free 
expectoration  of  foetid  pus.  Extensive  tuberculous  disease 
was  found  in  the  lungs  and  mesenteric  glands,  in  which  last, 
by  a curious  coincidence,  there  was  an  abscess  which  opened 
into  the  intestine ; the  specimen  is  in  the  Cabinet.  Bronchial 
glands  much  enlarged,  soft,  and  curdy.  The  cavity  behind 
the  root  of  the  trachea  was  more  than  an  inch  in  diameter, 
well  defined,  and  unlike  that  of  a common  tuberculous  abscess, 
the  inner  surface  being  rather  dark,  and  the  surrounding  parts 
forming  the  parietes,  except  in  one  place,  where  was  attached 
some  soft,  pulpy  substance  which  looked  a little  sloughy ; the 
opening  into  the  (Esophagus  is  one  and  a half  or  two  lines  in 
diameter,  and  there  are  one  or  two  others,  which,  however, 
are  much  smaller.  1838. 

The  above  termination  must  be  quite  rare,  as  compared 
with  an  opening  into  the  trachea;  a case  may  therefore  be 
mentioned,  which  was  similar  to  the  above,  both  as  to  the  open- 
ing into  the  oesophagus,  and  the  gangrenous  appearance  of  the 


126 


ALIMENTARY  CANAL. 


cavity,  and  which  was  reported  to  the  Society  by  Dr.  Samuel 
Parkman,  the  specimen  being  exhibited  at  the  same  time ; 
there  was,  however,  an  opening  into  the  trachea  also  in  Dr. 
Parkman’s  case. 

iv.  Pleura. 

448.  “ Ossification  of  the  pleura ; ” a thin,  rough  plate  of  cretaceous 

rather  than  ossific  matter,  about  two  inches  in  length  and  one 
in  width.  Dr.  Walter  Charming. 

449.  “ Ossification  of  the  pleura.”  Two  thin  plates  of  bone ; sur- 
face and  edges  irregular ; one  is  five  and  a half  inches  in 
length,  and  from  one  to  two  inches  in  width ; the  other  is  three 
inches  and  a half  by  one  inch  and  a half.  Soft  parts  removed 
by  maceration.  They  were  situated  over  the  upper  lobe  of  the 
left  lung,  and  were  easily  removed  by  raising  the  costal  pleura. 
The  left  upper  lobe  was  healthy,  but  there  was  some  old 
tuberculous  disease  in  the  right  upper  one,  with  chronic  disease 
in  abdomen.  The  patient,  aged  seventy,  formerly  a celebrated 
school-master  in  this  city,  entered  the  Mass.  Gen.  Hospital 
January  10th,  1844,  with  apoplexy,  and  died  on  the  18th. 


VII.  ALIMENTARY  CANAL, 
i.  Healthy  Anatomy. 

450.  A series  of  foetal  stomachs,  the  respective  ages  of  the  subjects 

being  marked  on  each.  Dr.  J.  B.  S.  Jackson. 

451.  A series  to  show  the  development  of  the  appendix  coeci,  and 
the  ileo-ccecal  portion  of  intestine.  Dr.  J.  B.  S.  Jackson. 

452.  Intestine  inflated,  dried,  and  cut  open,  to  show  the  ileo-coecal 

valve.  Dr.  J.  B.  S.  Jackson. 

453.  A portion  of  intestine  from  a foetus,  minutely  injected  and 

dried.  Dr.  J.  B.  S.  Jackson. 


ALIMENTARY  CANAL. 


127 


454.  A portion  of  dried  intestine,  intended  to  show  the  redness  of 
Peyers’s  patches,  which  has  been  observed  in  persons  dying 
suddenly,  whilst  the  process  of  digestion  is  going  on;  the 
color,  however,  is  much  faded.  The  patient,  aged  thirteen 
months,  died  in  a fit,  having  been  subject  to  such  attacks  for 
the  last  six  months,  though  otherwise  quite  healthy.  The 
patches  were  very  decidedly  reddened  throughout  the  whole 
track  of  the  small  intestine,  though  more  so  in  the  lower  half, 
and  a few  were  of  a deep  red  color ; some  thickening,  but  this 
was  perhaps  connected  with  the  age  of  the  subject ; no  soften- 
ing. Mucous  membrane  generally  not  remarkable.  The 
intestine  contained  much  pasty  substance  colored  by  bile,  and 
the  mesenteric  glands  and  lacteals  were  filled  with  chyle ; the 
stomach  also  contained  a considerable  quantity  of  slightly 
curdled  milk. 

I have  met  with  this  condition  of  Peyer’s  patches  many 
times  in  cases  of  sudden  death,  whether  from  accident  or  dis- 
ease, and  once  it  was  found  very  strongly  marked  in  a horse 
that  was  killed  on  account  of  some  lameness ; chyle  was  gen- 
erally found  in  the  lacteals,  and  chyme  in  the  intestine  ; some- 
times the  mucous  coat  of  the  stomach  and  duodenum  was 
found  reddened,  as  described  by  Dr.  Yelloley  in  the  Med. 
Chir.  Trans.,  but  oftener  not.  It  should  be  remarked,  that 
though  the  patches,  as  a whole,  looked  red,  the  individual  fol- 
licles, of  which  they  are  composed,  often  appeared  white, 
being  filled  with  a milky  secretion  which  could  readily  be 
forced  out.  The  redness  of  the  patches  seems  to  be  somehow 
connected  with  the  process  of  digestion,  and  is  to  be  explained 
in  the  same  way  as  the  redness  which  is  so  often  seen  in  the 
mucous  coat  of  the  stomach  in  persons  who  have  died  whilst 
this  process  was  going  on.  The  above  case  occurred  in  the 
year  1837,  that  of  the  horse  in  1836,  and  most  of  the  others 
within  a few  years  of  the  same  time.  1847. 

Dr.  J.  B.  S.  Jackson. 

455.  A portion  of  small  intestine,  inflated  and  dried ; from  a man, 
who  was  disinterred,  after  having  been  buried  four  years  and 
eleven  months.  The  whole  body  was  most  remarkably  pre- 
served, and  might  have  been  used  for  common  anatomical 
purposes,  the  interior  of  the  bladder,  particularly,  looking  like 


128 


ALIMENTARY  CANAL. 


that  of  one  recently  dead.  The  individual  probably  died  from 
the  effects  of  arsenic,  though,  on  a partial  chemical  examina- 
tion of  the  internal  organs,  none  was  discovered.  1840. 

Dr.  J.  B.  S.  Jackson. 


ii.  Malformation. 

456.  Malformation  of  the  oesophagus,  from  a patient  of  Dr.  Walter 
Channing.  Superiorly,  the  canal  can  hardly  be  said  to  exist, 
as  it  terminates  at  once  in  a cul  de  sac  behind  the  larynx; 
inferiorly,  it  opens  freely  into  the  trachea,  just  above  the  bifur- 
cation, but  below  this  it  is  sufficiently  well  developed.  The 
child  lived  five  days,  and  died  at  last,  apparently  from  pneu- 
monia, every  attempt  to  swallow  liquids  causing  great  distress, 
with  lividity,  and  almost  suffocation.  1839. 

457.  A second  specimen,  similar  to  the  last ; from  a patient  of  Dr. 
J.  Bigelow.  The  child  was  born  at  the  full  period,  and  well 
developed.  On  the  second  day,  it  was  observed  to  take  the 
breast  with  avidity,  but,  after  a few  minutes  seemed  to  vomit ; 
liquids,  also,  when  put  into  the  mouth,  were  immediately 
rejected ; this  continued  with  much  distress,  and  an  increasing 
emaciation,  till  the  eighth  day,  when  it  died.  Occasionally  the 
respiration  was  obstructed  by  a kind  of  spasm ; and  there  was 
constantly  heard  over  the  chest  a mucous,  and  towards  the  last 
a subcrepitous  rale. 

The  upper  part  of  the  oesophagus  is  large,  quite  muscular, 
and  terminates  in  a cul  de  sac  about  opposite  the  middle  of  the 
trachea.  The  lower  portion,  which  is  smaller,  opens  freely 
into  the  trachea,  just  above  the  bifurcation.  The  stomach  was 
much  distended,  containing  a considerable  quantity  of  brown, 
viscid  fluid,  and  a large  quantity  of  extremely  viscid  mucus, 
which  adhered  almost  everywhere  to  the  inner  surface,  the 
membrane  itself  being  softened,  as  if  by  the  action  of  gastric 
juice.  The  whole  of  the  left  lung,  except  for  a trace  of  healthy 
tissue  at  the  base,  and  about  one-third  of  the  lower  lobe  of  the 
right  lung,  were  in  a state  of  the  most  complete  apoplexy, 
looking  like  a mass  of  black-currant  jelly.  The  uterus  was 
malformed,  and  the  vagina  entirely  wanting,  though  there  was 
nothing  unusual  in  the  external  organs.  It  was  found,  also, 


ALIMENTARY  CANAL. 


129 


that  the  common  trunk  of  the  left  subclavian  and  jugular  veins 
entered  the  right  auricle  by  a separate  opening ; instead  of 
uniting  with  the  vena  cava.  The  other  organs  were  well 
formed. 

It  is  remarkable  that  this  malformation  of  the  oesophagus, 
which  is,  according  to  M.  Andral,  quite  rare,  has  been  met 
with  in  two  other  cases,  at  least,  in  this  neighborhood,  one  of 
them  terminating  in  eight  days,  and  the  other  in  about  twenty- 
four  hours. 

458.  Several  specimens  of  diverticula,  from  the  lower  part  of  the 

ileum,  showing  the  difference  of  form  and  size  in  different 
subjects.  Dr.  J.  B.  S.  Jackson. 

459.  Appendix  cceci,  nearly  seven  inches  in  length. 

Dr.  J.  B.  S.  Jackson. 

460.  Imperforate  anus  ; a dry  preparation.  From  a patient  of  Dr. 
J.  H.  Lane.  The  child  was  quite  healthy  at  birth.  On  the 
third  day  vomiting  came  on  with  distress ; the  vomiting  con- 
tinued only  a day  or  two,  but  the  distress  was  urgent  throughout, 
with  great  swelling  of  the  abdomen,  though  the  child  was  kept 
constantly  under  the  influence  of  paregoric  ; became  much 
emaciated,  and  died  on  the  ninth  day.  This  case  occurred  in 
March,  1837,  and  another  infant  in  the  same  family  has  since 
died  of  malformation  of  the  heart.  (No.  339.) 

The  rectum  was  immensely  distended,  and  appeared  to  end 
in  a cul  de  sac ; on  further  examination,  however,  there  was 
found  a minute,  capillary  opening  into  the  urethra  just  in  front 
of  the  verumontanum. 

Such  an  opening  as  existed  here  I have  seen  noticed  in  the 
reports  of  individual  cases,  but  not  as  a general  fact ; in  every 
one,  however,  of  six  cases  that  I have  as  yet  examined,  i.  e.  of 
imperforate  anus  in  the  male  subject,  the  rectum  appearing  to 
terminate  in  a cul  de  sac  low  in  the  pelvis,  a minute  opening 
has  been  found  into  the  urethra,  and  just  in  front  of  the  veru- 
montanum. 

461.  A second  specimen,  similar  to  the  last,  the  rectum,  however, 
being  much  less  distended ; a dry  preparation.  From  a patient 

17 


130 


ALIMENTARY  CANAL. 


of  Dr.  George  B.  Doane.  Deatli  occurred  on  the  eighth  day, 
the  symptoms  being  very  much  as  in  the  last  case,  except  for 
a remarkable  failure  in  the  secretion  of  urine.  A trace  of 
meconium  was  once  observed  upon  the  diaper,  having  found 
its  way  through  the  opening  into  the  urethra ; this  I have 
noticed  in  one  other  case.  An  operation  here  was  attempted, 
but  the  rectum  was  not  opened.  March,  1837. 


462.  Imperforate  rectum ; from  a patient  of  Dr.  John  Flint.  A dry 
preparation.  The  intestine  runs  a straight  course,  dilates 
gradually,  and  terminates  rather  bluntly  in  a cul  de  sac,  meas- 
uring one  inch  and  a*  quarter  in  diameter  at  that  part.  The 
patient,  a male  child,  lived  until  about  the  sixth  day.  The  anus 
was  open,  and  about  half  an  inch  of  intestine  was  developed, 
the  imperforate  portion  being  about  the  same  in  extent. 
March,  1846. 


463.  Imperforate  rectum  ; from  a patient  of  Dr.  William  J.  Dale. 

A dry  preparation.  The  intestine  dilates 
abruptly  into  a cavity  of  a regular  ovoid 
form,  and  measures  three  and  a half 
inches  in  length,  the  colon,  which  is  but 
moderately  dilated,  being  bent  strongly 
upon  it,  as  shown  in  the  adjoining  figure. 
The  child  was  otherwise  well  formed,  and 
died  on  the  ninth  day,  having  never  been 
much  distressed,  except  once  after  a 


cathartic.  1845. 

In  another  specimen,  recently  shown  to  the  Society,  there 
was  a much  more  abrupt  dilatation  than  in  the  present  case, 
and  it  deserves  to  be  noticed,  as  similar  dilatations  do  not 
seem  to  have  been  generally  remarked,  this  specimen  resem- 
bling somewhat  in  form  a junk  bottle,  as  the  other  does  a chem- 
ical retort.  The  lower  portion  of  the  intestine  was  less  devel- 
oped than  in  the  other  cases,  and  would  admit  a probe  only  to 
the  extent  of  one-third  of  an  inch.  Another  unusual  malforma- 
tion was  observed  in  this  case,  on  a slight  examination  of  the 
specimen  after  its  removal  from  the  body ; the  vesiculse  seminales 
were  not  found,  but  in  their  place  a cyst  of  considerable  size 
and  thickness,  quite  smooth  and  regular  on  the  inner  surface, 


ALIMENTARY  CANAL. 


131 


filled  with  viscid  mucus,  as  the  vesiculse  usually  are,  and  having 
a single  opening  upon  the  middle  of  the  verumontanum. 

464.  Imperforate  rectum  ; from  a patient  of  Dr.  John  Ware.  A 
wet  preparation.  The  upper  and  lower  portions  of  the  intes- 
tine terminate  in  a cul  de  sac,  a short  distance  from  the  anus, 
the  impervious  portion  being  about  one-third  of  an  inch  in  extent. 
From  a healthy  male  infant ; had  constant  vomiting,  with  much 
distress,  and  died  on  the  fourteenth  day.  The  lower  part  of 
the  small  intestine,  and  the  whole  of  the  large,  were  acutely 
inflamed,  with  ulceration  of  the  latter.  1840. 

465.  Imperforate  rectum,  as  in  the  last  case,  but  occurring  in  a 
female  subject;  symptoms  immediately  connected  with  the 
malformation  were  not  urgent.  On  the  third  day  an  operation 
was  attempted,  in  which  the  posterior  parietes  of  the  vagina 
were  extensively  wounded,  and  without  opening  the  intestine ; 
the  haemorrhage  was  copious,  and  the  child  died  in  seventeen 
hours.  1839. 

466.  Rectum  opening  largely  into  the  upper  part  of  the  vagina, 
from  a child  about  three  months  old,  and  a patient  of  Dr. 
William  J.  Walker.  A wet  specimen.  Dr.  W.  made  an 
opening  into  the  intestine,  through  which  the  faeces  passed  for 
some  time,  but,  for  two  or  three  weeks  before  death,  this  was 
closed,  and  the  discharges  passed  as  before  through  the  vagina. 
The  rectum  is  seen  to  have  been  dilated  and  the  muscular  coat 
much  thickened.  1839. 

ill.  Pharynx  and  (Esophagus. 

467.  Constriction  of  the  fauces  from  the  cicatrization  of  venereal 
ulcers,  the  patient  dying  of  asphyxia  and  starvation.  A piece 
of  whale-bone,  stretched  across  the  narrowest  part  of  the  canal, 
shows  the  circumference  to  have  been  only  about  two-thirds  of 
an  inch.  1834. 

468.  Ulceration  of  the  throat,  from  a case  of  scarlatina.  It  ex- 
tends across  the  root  of  the  tongue,  and  down  behind  the  larynx, 
laying  bare  the  posterior  edge  of  the  thyroid  cartilage  on  the 


132 


ALIMENTARY  CANAL. 


left  side  ; the  epiglottis  is  still  thickened,  but  was  very  much 
so  in  the  recent  state ; the  tonsils  and  uvula  are  destroyed,  and 
the  whole  diseased  surface,  as  well  as  the  mucous  membrane 
of  the  larynx  and  trachea,  were  covered  thickly,  when  recent, 
with  adhesive  mucus  and  lymph.  The  patient  was  a little  girl, 
five  years  old,  and  had  regurgitation  with  an  appearance  of 
strangulation  on  attempting  to  swallow  liquids,  besides  other 
urgent  symptoms.  1833. 

469.  Dilatation  of  the  oesophagus.  At  the  time  of  the  dissection  it 
extended  into  the  right  side  of  the  chest,  and  was  so  large  as 
easily  to  admit  the  fist,  the  muscular  coat  being  much  thick- 
ened. The  cardiac  orifice  of  the  stomach  was  contracted,  but 
not  scirrhous.  The  specimen,  having  been  dried  and  cut  open, 
has  become  much  contracted.  From  a female,  about  forty 
years  of  age.  She  had  had  dysphagia  for  twenty  years ; great 
effort  required  in  swallowing,  the  food  being  sometimes  forced 
down,  and  at  other  times  rejected ; had  sufficient  flesh,  her 
general  health  was  tolerably  good,  and  she  ultimately  died  of 
phthisis.  May,  1839. 

The  specimen  was  sent  in  its  present  condition,  with  the 
above  account  of  the  case,  by  the  late 

Dr.  Charles  O.  Barker , of  Lynn. 

470.  Great  contraction  of  the  oesophagus.  A little  girl,  two  years 
old,  drank  some  Potash  water,  prepared  for  cleaning  tripe. 
For  the  first  week  she  complained  of  scalding  of  the  tongue, 
but  was  not  much  sick ; afterwards  there  came  on  dysphagia, 
the  food  being  rejected  when  half  swallowed,  but  not  as  by 
vomiting;  deglutition  occasionally  easy.  Desire  for  drink  so 
urgent,  that  she  would  sometimes  use  a bucket-full  of  water  in 
the  course  of  the  night,  nearly  the  whole  of  which  would  be 
regurgitated.  Lived  three  years  after  the  accident,  and  died 
from  inanition.  The  lower  half  of  the  oesophagus  is  greatly 
contracted,  and  to  the  extent  of  about  an  inch,  so  much  so  that, 
in  the  recent  state,  a probe  would  scarcely  pass  through.  The 
small  portion  of  the  canal  which  is  seen  above  the  contracted 
part  does  not  seem  to  have  been  much  dilated.  May,  1839. 

This  specimen  was  sent,  with  the  last,  to  the  Society  by 

Dr.  Charles  O.  Barker , of  Lynn. 


ALIMENTARY  CANAL. 


133 


471.  Scirrhus  of  the  oesophagus,  about  midway,  and  to  the  extent 
of  one  inch  and  a half ; there  is  not  much  thickening,  but  the 
surface  is  ulcerated,  and  the  muscular  coat  has  the  characteristic 
striated  appearance.  From  a man,  sixty-six  years  of  age ; 
had  for  a long  time  complained  of  pain  in  the  throat  on  swal- 
lowing solid  food,  and  vomiting  usually  followed  an  hour  or 
two  after  taking  it.  When  recent,  the  contraction  appeared 
very  much  greater  than  at  present.  May,  1834. 

472.  Ulceration  of  the  oesophagus,  opening  largely  into  the  trachea, 
just  above  the  bifurcation ; from  a patient  of  Dr.  A.  L.  Peirson, 
of  Salem.  The  disease  is  two  inches  in  extent,  affects  the  whole 
calibre  of  the  tube,  and  has  altogether  a very  unhealthy,  if  not 
a malignant  aspect.  From  a female,  who  had  had  dysphagia 
for  a year  or  two,  and  whose  sufferings  for  the  last  few  months 
had  been  very  great. 

iv.  Stomach. 

473.  Stomach,  showing  the  effects  of  Elaterium.  The  patient,  a 
young  woman,  eighteen  years  of  age,  took  from  an  empiric,  in  the 
course  of  six  hours,  two  grains  and  two  fifths  of  the  drug,  with 
sixteen  grains  of  rhubarb,  and  died  in  forty-two  hours.  The 
symptoms  were  incessant  vomiting,  with  great  distress  in  the 
abdomen,  thirst,  and  prostration,  the  countenance  appearing  as 
in  cholera;  the  effect  on  the  bowels,  however,  was  very  mode- 
rate, there  being  no  discharge  after  the  first  twelve  hours, 
neither  was  there  any  passage  of  urine  during  that  time.  The 
stomach  was  enormously  distended,  and  contained  a quart  or 
more  of  a dark  brown  fluid,  giving  to  the  mucous  membrane  a 
color  which  is  still  well  preserved:  the  orifices  of  numerous 
follicles  are  also  seen  ; when  recent,  the  external  surface  was 
greyish  and  very  diy.  The  intestines  were  inflamed,  and  the 
colon  very  much  contracted.  The  case  was  published  in 
detail  in  the  Boston  Medical  Magazine  for  July,  1834. 

474.  Chronic  ulcer  in  the  body  of  the  stomach,  about  an  inch  in 
diameter.  The  organ  adhered  to  the  spine  at  this  part,  and, 
on  dissecting  it  up,  the  base  of  the  ulcer  was  cut  away.  From 
a dyspeptic  female,  thirty-five  years  of  age. 


134 


ALIMENTARY  CANAL. 


475.  A second  specimen  of  the  same.  The  ulcer  is  near  the 
pylorus  and  about  one-third  of  an  inch  in  diameter.  From  a 
female,  twenty-four  years  of  age,  who  had  been  dyspeptic  for 
a year  or  two  ; thirty  hours  before  death  perforation  took  place, 
and  she  died,  as  usual,  from  acute  peritonitis. 

476.  Chronic  ulcers  at  the  pylorus;  perforation.  From  a patient 
of  Dr.  Morrill  Wyman,  of  Cambridge.  Two  well-defined, 
deep  ulcers,  of  a circular  form,  and  about  half  an  inch  in 
diameter,  are  situated  opposite  to  each  other,  and  just  upon  the 
pylorus,  a large  opening  through  into  the  peritoneal  cavity 
being  seen  in  the  base  of  one  of  them.  Between  the  ulcers  is 
something  like  a yielding  of  the  parietes  of  the  stomach,  form- 
ing a shallow,  ill-defined  cavity,  and  which  might  be  mistaken 
for  the  remains  of  another  ulcer,  and  just  opposite  to  this,  upon 
the  duodenal  side  of  the  pylorus,  is  the  same  appearance, 
though  to  a less  extent.  The  pyloric  portion  of  the  stomach 
was  somewhat  rough,  with  slight  follicular  disease,  and  two 
small,  ill-defined  ulcerations.  In  the  peritoneal  cavity  was 
found  some  recent  lymph,  besides  the  liquids  and  gas  that  had 
escaped  from  the  stomach.  The  patient  was  a merchant,  sixty- 
three  years  of  age,  who  had  been  dyspeptic  for  a long  while, 
but  for  the  last  one  or  two  years  much  less  so,  if  at  all ; not 
subject  to  vomiting.  On  the  third  of  May,  1845,  whilst  walk- 
ing on  his  piazza  at  noon,  he  complained  of  a great  sense  of 
weight  at  the  epigastrium;  at  11  o’clock,  P.  M.,  he  sent  for 
Dr.  W.,  on  account  of  a pain  in  the  abdomen,  and  this  con- 
tinued as  a marked  symptom,  though  it  was  by  no  means 
urgent,  as  is  usual  in  these  cases ; the  pulse  in  the  evening,  and 
again  towards  morning,  were  but  72,  but  afterwards  became 
more  rapid,  with  symptoms  of  collapse,  which  continued  till 
his  death,  on  the  following  evening  at  10  o’clock. 

477.  A third  specimen  of  the  same;  death  from  haemorrhage. 
From  a patient  of  Dr.  D.  H.  Storer ; he  was  a middle-aged 
man,  and  complained  of  pain  in  his  stomach,  diminished  appe- 
tite, constipation,  and  a general  indisposition,  though  he  had 
not  given  up  his  work.  A cathartic  was  given,  and  on  the 
following  day  he  was  better.  On  the  third  day  he  had  profuse 
hematemesis,  and  in  the  night  a second  attack,  after  which  he 


ALIMENTARY  CANAL. 


135 


died.  The  ulcer  is  towards  the  pyloric  portion,  and  near  the 
small  curvature,  of  an  oval  form,  and  more  than  an  inch  in 
length.  The  edges  are  not  thickened  and  indurated,  as  usual 
in  these  cases,  and  as  is  well  shown  in  the  other  specimens. 
In  the  base  of  the  ulcer  is  seen  the  open  orifice  of  a ruptured 
blood-vessel.  1838. 

A case,  which  has  been  reported  to  the  Society  by  Dr.  A. 
A.  Gould,  since  the  above,  may  he  mentioned  here,  on  account 
of  some  peculiarities  in  its  history,  the  specimen  having  been 
exhibited.  In  the  first  place,  there  were  two  ulcers,  instead  of 
one,  as  usual ; secondly,  they  were  situated  towards  the  left 
extremity,  instead  of  the  right,  and  lastly,  as  to  the  mode  of 
death;  the  patient  had  no  external  discharge  of  blood,  but 
became  suddenly  very  faint,  when  in  the  act  of  brushing  her 
teeth,  and  died  in  a few  minutes,  a large  quantity  of  blood 
being  found  in  the  stomach,  and  throughout  the  intestines. 

478.  Chronic  ulcer  of  the  stomach;  haemorrhage,  and  subsequently 
perforation.  From  a patient  of  Dr.  Hiram  Hosmer,  of  Water- 
town.  The  ulcer  is  one  inch  from  the  pylorus,  in  the  small 
curvature,  of  an  oval  form,  and  measures  two  inches  in  length ; 
the  base,  when  recent,  was  of  a dark,  brownish  color,  probably 
from  the  haemorrhage,  and  in  it  is  seen  the  perforation  about 
one-third  of  an  inch  in  diameter,  and  looking,  as  in  similar 
cases,  as  if  a piece  had  been  punched  out.  The  patient,  a 
laboring  man,  aged  forty-four,  had  been  for  many  years  very 
intemperate,  though  much  less  so  for  the  last  six  months.  For 
some  months  he  had  had  pain  in  the  region  of  the  stomach 
after  eating,  and  in  the  night  had  frequently  vomited.  On  the 
7th  of  May,  1845,  he  had  a copious  haemorrhage  from  the 
stomach  and  bowels ; the  bleeding,  however,  did  not  recur 
after  the  second  day,  and  he  gradually  improved,  so  as  to  be 
able,  on  the  19th,  to  walk  out.  At  11  P.  M.,  on  this  last  date, 
he  was  awaked  by  a violent  pain  in  the  region  of  the  stomach ; 
an  hour  afterwards  he  was  found  by  his  physician  pulseless, 
and  in  a state  of  collapse,  and  at  10  A.  M.,  on  the  following 
day,  he  died.  On  dissection,  a great  quantity  of  liquid  and 
food  was  found  in  the  cavity  of  the  abdomen,  but  there  was  no 
peritonitis. 


136 


ALIMENTARY  CANAL. 


479.  Deep  cancerous  ulceration  of  the  last  two  and  a half  inches 
of  the  oesophagus,  with  thickening  and  contraction ; a small 
portion  of  the  stomach  is  preserved,  and  shows  a scirrhous 
affection  of  the  small  curvature,  the  disease  having  extended 
to  the  pylorus.  From  a gentleman,  seventy-two  years  of  age, 
a patient  of  Dr!  John  Homans.  About  eight  or  ten  months 
before  death  he  began  to  have  difficulty  in  swallowing  solid 
food,  and  took  pudding  only,  but  soon  this  troubled  him,  and  he 
abstained  almost  entirely ; pain,  and  a sense  of  oppression 
were  felt  beneath  the  lower  end  of  the  sternum  after  swallowing. 
Soon  afterwards  he  began  to  vomit  his  food,  with  much  distress, 
and  these  symptoms  continued,  though,  when  the  stomach  was 
empty,  he  was  sufficiently  comfortable.  1830. 

480.  Scirrhous  stomach,  from  a patient  of  Dr.  John  Jeffries.  The 
disease  involves  the  pyloric  portion  and  small  curvature,  and 
altogether  one-half  or  more  of  the  entire  organ,  ulceration 
having  commenced  near  the  pylorus.  Muscular  coat  in  the 
healthy  portion  not  hypertrophied,  as  described  by  M.  Louis, 
nor  do  I remember  to  have  met  with  this  change  more  than 
once  or  twice  in  these  cases.  The  whole  organ  was  much 
contracted  in  size,  and  seemed  to  be  drawn  into  the  left  hypo- 
chondrium,  the  tumor,  which  was  felt  during  life,  being  quite 
to  the  left  of  the  median  line,  and  sometimes  fairly  beneath 
the  cartilages  of  the  ribs.  The  omentum  was  also  scirrhous, 
as  seen  in  the  preparation ; a small  scirrhous  mass  was  also 
found  in  the  liver,  where  it  adhered  to  the  stomach.  From  a 
gentleman,  thirty-six  years  of  age.  The  symptoms  in  this 
case  were  quite  peculiar ; about  three  years  before  death  he 
began  to  spit  up  his  food,  without  nausea,  the  taste  being 
scarcely  altered ; this  would  come  on,  not  at  any  stated  period 
after  eating,  but  whenever  he  began  to  move  about,  and  the 
quantity  thus  thrown  off  was  sometimes  very  great.  This 
attack  lasted  three  or  four  weeks,  and  he  afterwards  had  a 
second,  his  health  during  the  intervals  being  quite  good.  The 
last  attack,  which  came  on  five  months  before  death,  was 
probably  owing  to  great  anxiety  in  business,  and  under  this  he 
gradually  sank ; the  chief  symptoms  were  the  spitting  up  of 
food,  as  before,  an  inordinate  appetite,  obstinate  constipation, 
and  great  emaciation ; he  had  no  uncomfortable  feeling  at  epi- 


ALIMENTARY  CANAL. 


137 


gastrium,  and  yet  he  never  could  bear  pressure  there ; the 
tumor  was  first  felt  six  weeks  before  death.  1834. 

481.  A second  specimen  of  scirrhous  stomach;  sent  to  the  Society 
by  Dr.  A.  L.  Peirson,  of  Salem.  The  disease  is  in  the  body 
of  the  organ,  about  midway,  the  extremities  being  healthy;  the 
entire  circumference  is  affected,  and  the  contraction  was  such 
as  hardly  to  allow  the  passage  of  the  finger,  the  stomach 
appearing  as  if  tied  round  by  a band ; in  the  large  curvature 
was  a superficial  ulcer,  an  inch  in  diameter.  The  patient  was 
Dr.  H.,  of  Salem,  aged  one  hundred  years  and  eight  months. 
About  four  months  before  his  death,  which  occurred  on  the  31st 
of  March,  1829,  he  met  with  an  accident,  from  which  time  his 
health  gradually  declined,  and  he  suffered  from  pain  in  the 
epigastrium,  depression  of  spirits,  and  other  symptoms  of  dis- 
ease. A full  account  of  the  case  is  given  in  the  Memoir  of 
Dr.  H.,  which  was  published  by  the  Essex  South  District  Medi- 
cal Society. 

482.  Extensive  and  deep  cancerous  ulceration  in  the  pyloric  portion 
of  the  stomach.  In  the  midst  of  this  mass  of  disease,  a strip 
of  healthy  parietes  remains,  guarded  on  each  side  by  a broad, 
prominent,  cauliflower-looking  excrescence,  as  if  to  secure  a 
passage  for  the  food  from  the  stomach  into  the  duodenum. 
From  an  old  woman,  who  died  at  the  Alms-house  many  years 
since. 

483.  Scirrhus  of  the  pyloric  portion  of  the  stomach.  There  is  also 
much  disease  in  the  cellular  membrane,  and  in  the  omentum 
connecting  the  stomach  with  the  arch  of  the  colon ; the  intes- 
tine almost  adhered  to  the  stomach,  and  was  at  one  part  so 
much  contracted  as  not  to  allow  the  passage  of  the  little  finger. 
There  was  extensive  ascites  in  this  case,  and  a peculiar,  per- 
haps malignant  disease  of  the  ovaries ; the  specimen  is  in  the 
Cabinet.  The  patient  was  a school-mistress,  forty-one  years  of 
age,  and  died  at  the  Mass.  Gen.  Hospital  in  April,  1832,  having 
been  there  tw'o  years  before  with  dyspepsia,  and  hepatic  symp- 
toms. About  a month  before  her  death  there  came  on  a vomit- 
ing and  spitting  up  of  food,  and  dark  brown  matter,  with  eruc- 
tation, and  much  distress  at  the  stomach. 

18 


138 


ALIMENTARY  CANAL. 


484.  Very  extensive  encephaloid  disease  of  the  cardiac  portion  of 
the  stomach. 

v.  Small  Intestine. 

485.  Rupture  of  the  intestine  from  a kick  of  a horse.  The  patient 
was  a hostler,  forty  years  of  age,  and  entered  the  Mass.  Gen. 
Hospital  on  the  forenoon  of  January  20th,  1839.  Accident 
happened  about  twelve  hours  before  ; received  the  blow  on  the 
left  side  of  the  abdomen,  and  was  immediately  seized  with 
violent  pain,  &c. ; not  relieved  by  venesection.  On  admission, 
he  was  in  a state  of  collapse ; abdomen  exceedingly  painful 
and  tender,  swollen  and  resonant  at  the  upper  part,  but  very 
dull  towards  left  hypogastrium,  and  without  any  mark  of  exter- 
nal injury;  hiccough  and  vomiting;  no  discharge  from  the 
bowels,  and  was  unable  to  void  his  urine.  Continued  to  sink, 
and  died  about  seventeen  hours  after  the  accident.  On  dissec- 
tion, four  hours  after  death,  there  was  found  in  the  peritoneal 
cavity  about  three  quarts  of  a grey  fluid,  mixed  with  ingesta ; 
some  escape  of  air  on  opening  the  cavity.  Great  vascularity 
of  the  intestines,  but  this  may  have  been  owing  to  the  process 
of  digestion,  as  the  villosities  of  the  mucous  membrane  in  some 
parts  seemed  filled  with  chyle.  One  perforation  was  found  at 
the  upper  part  of  the  jejunum,  and  two  others  at  some  distance 
below,  and  within  an  inch  of  each  other ; they  were  sufficiently 
large  to  admit  the  end  of  the  little  finger,  and  the  edges  were 
strongly  everted  ; some  recent  lymph  is  seen  about  them.  It 
was  remarkable  that,  though  the  parietes  of  the  abdomen  were 
not  immediately  injured  by  the  blow,  there  was  considerable  ec- 
chymosis  in  the  mesentery  connected  with  the  ruptured  intestine. 

486.  Hernia  of  the  mucous  membrane  of  the  duodenum.  Two 
sacs,  about  the  size  of  large  English  walnuts,  arose  abruptly 
from  the  intestine,  one  being  situated  just  at  the  opening  of  the 
bile  duct,  as  seen  in  the  preparation,  and  the  other  about  an 
inch  nearer  to  the  pylorus ; orifices  large,  though  smaller  than 
the  cavity  within.  As  in  a case  which  has  beemdescribed  by 
Morgagni,  (Letter  xxxiv.  art.  17.)  The  parietes  consisted  solely 
of  mucous  membrane  and  a little  cellular  tissue,  the  muscular  be- 
ing wholly  wanting,  though  rather  thick  in  the  surrounding  intes- 


ALIMENTARY  CANAL. 


139 


tine ; mucous  membrane,  within  the  sacs,  rather  thick  and 
opaque.  When  first  seen,  in  the  dissection,  these  sacs  appeared 
like  thin  serous  cysts.  The  intestine,  having  been  cut  open, 
the  sacs  were  carefully  stuffed,  and  the  whole  was  then  dried 
over  a cylinder.  From  a man,  aged  sixty-five,  who  died  from 
an  encephaloid  disease  of  the  cardiac  portion  of  the  stomach ; 
his  death  at  last  was  sudden,  and  owing  to  haemorrhage,  the 
stomach  and  intestines  containing  large  quantities  of  blood, 
besides  much  that  was  passed  from  the  bowels  during  life.  1 844. 

Dr.  J.  B.  S.  Jackson. 

487.  Polypus  of  the  intestine ; from  a patient  of  Dr.  Woodbridge 
Strong.  It  consists  of  a regular,  pyriform  mass,  about  one 
inch  in  length,  and  one-third  of  an  inch  in  diameter  at  the 
largest  part,  fleshy  to  the  feel,  and  somewhat  rough  on  the 
surface,  but  covered  apparently  by  mucous  membrane.  It 
arose  from  the  ileum,  about  one  foot  from  the  csecum,  and  a 
portion  of  the  intestine  is  preserved  in  connection  with  it.  A 
portion  of  the  upper  part  of  the  jejunum  is  also  preserved, 
showing  a commencing  polypus,  somewhat  of  the  form,  though 
rather  larger  than  a grape ‘seed,  and  these  two  were  all  that 
were  found,  the  intestines  having  been  opened  throughout. 
From  a woman,  aged  fifty-eight,  who  died  of  acute  dysentery. 
August,  1841. 

488.  Intussusception  at  the  junction  of  the  small  and  large  intestine, 
the  csscum  being  earned  forward  into  the  ascending  colon. 
From  a child. 

In  every  recent  case  of  intussusception  that  I have  as  yet 
seen,  excepting  one,  (No.  509)  it  has  been  at  the  above  situa- 
tion. 

489.  A second  specimen,  similar  to  the  last;  from  a patient  of  Dr. 
John  Homans.  The  invaginated  portion,  when  recent,  was  of 
an  intensely  dark  red  color,  swollen  and  covered  with  a bloody 
mucus,  the  large  intestine  containing  a thin  bloody  fluid.  The 
patient 'was  a healthy  male  infant,  seven  months  old.  Having 
had,  in  the  course  of  the  day,  two  green  discharges  from  the 
bowels,  but  appearing  otherwise  as  well  as  usual,  it  was 
attacked  at  five  o’clock,  P.  M.  with  paroxysms  of  distress, 


140 


ALIMENTARY  CANAL. 


which  continued  to  recur,  with  more  or  less  intervals  of  ease, 
till  death,  at  two  o’clock,  P.  M.  on  the  following  day.  During 
these  attacks  it  would  refuse  the  breast,  roll  up  the  eyes,  cry 
out  suddenly,  alternately  stiffen  and  relax  the  muscles,  and 
moan,  being  apparently  in  much  distress  ; there  was  very  little 
nausea,  but  much  tenesmus,  with  some  bloody  discharge  from 
the  bowels,  enemata  being  returned  almost  at  once.  1833. 

490.  A third  specimen,  in  which  the  caecum  and  ascending  colon 
are  carried  forward  into  the  arch.  From  a patient  of  Dr.  John 
Ware ; a healthy  infant,  aged  four  months,  attacked  on  the 
9th  of  August,  and  died  on  the  12th,  at  one  o’clock,  A.  M. ; 
the  prominent  symptoms  for  the  first  two  days  were  vomiting, 
with  dark  discharges  from  the  bowels,  some  of  them  consisting 
of  pure  blood ; on  the  third  day  less  vomiting,  but  more  pros- 
tration, the  surface  being  cold,  and  the  pulse  small  and  feeble 
throughout.  1831. 

491.  A fourth  specimen,  in  which  the  large  intestine  was  completely 
inverted  upon  itself,  so  as  to  be  felt  per  anum.  From  a patient 
of  Dr.  M.  S.  Perry;  an  infant,  aged  six  months,  and  previously 
quite  healthy,  except  for  obstinate  costiveness.  The  attack 
came  on,  as  her  mother  said,  with  a shaking  fit,  followed  by 
some  fever,  with  occasional  paroxysms  of  severe  pain.  A 
cathartic  was  given,  which  did  not  operate,  and  she  became 
extremely  restless,  frequently  crying  out,  drawing  up  the  feet, 
and  refusing  the  breast.  Had  some  tenesmus,  with  discharge 
of  bloody  mucus.  These  symptoms  continued  till  the  third 
day,  when  Dr.  P.  was  called.  He  found  the  skin  hot  and  dry, 
pulse  130,  tongue  nearly  clean,  countenance  rather  distressed. 
Had  vomited  during  the  night  previous  when  anything  was 
taken,  but  had  had  no  discharge  since  the  attack.  The  abdo- 
men was  full,  tympanitic,  and  tender.  All  the  diapers  that 
had  been  removed  during  the  night  were  stained  with  blood, 
the  tenesmus  being  still  urgent,  and  bloody  mucus  constantly 
oozing  from  the  bowels.  On  attempting  to  give  an  enema, 
the  pipe  met  with  some  obstruction,  and  the  fluid  came  away 
as  fast  as  it  was  thrown  in ; a complete  obstruction  existed 
about  an  inch  and  a half  from  the  anus,  and  pressure  with  the 
finger  against  it  caused  severe  pain,  followed  by  tenesmus,  and 


ALIMENTARY  CANAL. 


141 


a copious  flow  of  bloody  mucus,  the  nature  of  the  case  being 
then  quite  evident.  Some  remedies  were  tried,  but  the  rest- 
lessness, distress,  and  vomiting  increased,  and  the  child  died 
on  the  morning  of  the  sixth  day.  1837. 

No  tumor  was  found  in  the  abdomen  in  this  case ; in  another, 
however,  which  occurred  not  long  afterwards,  and  in  which  the 
displacement  was  equally  extensive,  there  was  a distinct  and 
visible  tumor  upon  the  left  side,  with  a corresponding  depres- 
sion and  feeling  of  emptiness  upon  the  right  side  of  the 
abdomen. 

492.  A sixth  specimen,  from  a patient  of  Dr.  J.  Bigelow.  He  was 
twenty-three  years  of  age,  had  had  well  marked  typhoid  fever 
for  five  and  a half  weeks,  and  seemed  to  be  convalescent, 
w'hen,  on  the  evening  of  November  1st,  Dr.  B.  was  called, 
and  found  him  with  spasms  and  delirium  ; this  last  continued 
till  death,  which  occurred  during  the  night  of  the  3d.  There 
was  considerable  meteorism  before  death,  and  on  the  last  eve- 
ning he  vomited  some  green  bile,  from  which  time  he  sank. 
Nothing  led  to  a suspicion  of  the  accident  which  had  occurred. 
On  dissection,  besides  the  disease  of  Peyer’s  glands,  and  ulcer- 
ation of  the  large  intestine,  connected  with  the  fever,  there  was 
found  intussusception,  to  the  extent  of  three  inches,  at  the 
junction  of  the  small  and  large  intestine,  the  latter  containing,  as 
usual,  a considerable  quantity  of  blood. 

In  every  other  specimen  of  intussusception  occurring  at  this 
part  of  the  intestine  that  I have  examined,  the  caecum  has 
formed  the  extremity  of  the  invaginated  part,  and  this  without 
any  reference  to  the  extent  of  the  invagination ; in  this  case, 
however,  the  valve  very  nearly  retained  its  place,  and  the 
small  intestine  passed  on  through  it  to  the  extent  above  named, 
some  of  the  Peyer’s  patches  being  seen  upon  its  surface. 

493.  “ Diaphragmatic  hernia a diy  preparation.  Several  folds 

of  intestine  and  a great  portion  of  the  omentum  had  passed 
through  an  opening  in  the  left  side  of  the  diaphragm,  the 
omentum  adhering  to  the  pleura  on  that  side,  as  seen  in  the 
preparation.  From  a patient  at  the  Marine  Hospital,  Chelsea; 
he  had  been  stabbed  in  the  side  several  years  before,  and  was 
ever  afterwards  subject  to  severe  attacks  of  colic,  in  one  of 
which  he  died.  Dr.  S.  D.  Townsend. 


142 


ALIMENTARY  CANAL. 


494.  Strangulation  of  the  intestine  by  a band  of  false  membrane. 
The  patient,  a young  lady,  nineteen  years  of  age,  and  under 
the  care  of  the  late  Dr.  John  Dixwell,  was  attacked,  in  the 
course  of  the  forenoon  of  June  the  18th,  with  nausea,  which 
was  soon  followed  by  vomiting,  and  which  continued  almost 
incessantly  till  the  morning  of  her  death;  retention  of  faeces; 
abdomen  not  tense,  and  pain  not  urgent;  no  tumor.  Pulse 
never  indicated  bleeding  until  the  morning  of  the  20th,  when 
about  gviij.  of  blood  were  drawn,  after  which  she  sank  rapidly, 
and  died  at  three  o’clock,  P.  M.  On  dissection,  some  traces 
of  acute  peritonitis  were  found,  besides  old  adhesions  of  the 
omentum  to  the  caecum  and  neighboring  parietes.  A small, 
rounded,  dense  band  of  false  membrane,  apparently  less  than 
an  inch  in  length,  was  attached  by  one  extremity  nearly  over  the 
caecal  valve,  and  by  the  other  to  the  ileum  two  feet  and  four 
inches  from  its  termination,  the  intestine  to  this  extent  having 
passed  beneath  it,  and  been  girt  so  tightly  that  now  in  the 
preparation  the  band  is  nearly  buried.  The  strangulated  intes- 
tine, which  laid  altogether  in  the  cavity  of  the  pelvis,  was  of  a 
deep  red  color,  and  moderately  distended,  but  retained  its 
polish,  and  did  not  appear  cut  by  the  stricture.  Just  above  the 
strangulation,  the  ileum  contained  a considerable  quantity  of 
liquid  faeces,  and  the  valvulae  conniventes  were  quite  red. 
1834. 

495.  A second  specimen,  similar  to  the  last ; from  a patient  of  Dr. 
Robert  Thaxter,  of  Dorchester.  In  this  case  the  band  passes 
from  the  small  intestine  to  the  right  ovary  or  broad  ligament, 
and  has  strangulated  two  small  folds  or  knuckles  of  the  intes- 
tine, by  passing  round  them  in  “ a figure  of  8”  direction.  The 
intestine  was  full  of  liquid  above  the  strangulation,  but  empty 
below,  as  usual.  Old  peritoneal  adhesions.  The  patient,  a 
female,  fifty-eight  years  of  age,  was  attacked  in  the  night  with 
severe  pain  in  the  abdomen  and  sickness  at  the  stomach ; had 
the  usual  symptoms  of  obstruction  of  the  bowels,  and  died  at 
the  end  of  a week.  1840. 

496.  Strangulation  of  the  intestine  by  means  of  a diverticulum. 
This  last,  arising  from  the  lower  end  of  the  ileum,  adheres  by 
its  blind  extremity  to  the  mesentery,  and  through  the  ring  thus 


ALIMENTARY  CANAL. 


143 


formed  a portion  of  intestine  had  passed,  and  become  strangu- 
lated. “ The  patient  died  at  the  Marine  Hospital,  Chelsea, 
with  all  the  symptoms  of  bilious  colic,  having  frequently  had 
similar  attacks.”  Dr.  S.  D.  Townsend. 

497.  A second  specimen  of  strangulation  of  the  intestine  by  a diver- 
ticulum ; terminated  on  the  thirteenth  day  in  perforation  ; from 
a patient  of  Dr.  James  Jackson.  Very  full  notes  of  the  case 
were  taken  daily  by  Dr.  Charles  G.  Putnam,  and  of  these  the 
following  is  an  analysis : — 

The  patient  was  forty-six  years  of  age,  and  had  generally 
enjoyed  good  health.  Six  years  previously  he  had  had  an 
attack  which  resembled  colic,  and  lasted  eighteen  hours ; sud- 
denly, as  he  said,  “something  gave  way,”  and  the  symptoms 
were  immediately  relieved ; five  months  before  death  he  had  a 
second  similar  attack.  The  chief  symptoms  during  his  last 
illness  were  as  follows : — Severe  pain  in  the  umbilical  region 
on  the  first  day,  but  none  afterwards  until  the  perforation 
occurred,  excepting  a slight,  occasional  griping ; he  had,  how- 
ever, a constant  sense  of  uneasiness.  No  free  discharge  from 
the  bowels,  though  he  took  active  cathartic  medicine  either  by 
the  mouth  or  in  the  form  of  enemata  almost  daily ; occasionally 
brought  away  scybala,  and  sometimes  a small  quantity  of 
liquid  faeces.  On  the  sixth  day  of  disease  he.  passed  § iv.  of 
blood  besides  scybala,  with  relief,  on  the  seventh  some  mem- 
branous shreds,  and  on  the  tenth  blood  with  shreds  ; no  tenes- 
mus. There  was  more  or  less  vomiting  for  the  first  six  days,  and 
but  little,  if  any,  afterwards;  never  urgent,  and  not  more 
perhaps  than  would  be  occasioned  by  the  cathartics  given. 
Tongue  coated,  but  moist  until  the  tenth  day ; some  appetite, 
and  occasionally  took  beef  or  chicken  tea,  or  shells  with  relish ; 
some  tendency  to  hiccough  throughout  the  disease.  Abdomen 
soft  and  flaccid;  never  absolutely  tympanitic,  and  never  tender, 
even  on  the  deepest  pressure ; no  tumor.  Skin  well,  but  had 
perspiration  towards  the  last.  Pulse  varied  from  72  to  88  till 
the  seventh  day,  but  afterwards  from  112  to  120;  sometimes 
intermitting  every  sixth  beat,  but  not  otherwise  irregular. 
Began  to  sink  about  the  ninth  day,  as  shown  by  the  counte- 
nance, which  had  before  been  calm,  the  failure  of  the  pulse, 
and  a tendency  to  sigh,  the  respiration  having  previously  been 


144 


ALIMENTARY  CANAL. 


full  and  easy.  Kept  his  bed  throughout  sickness,  but  was  gen- 
erally up  several  times  daily  to  the  close-stool ; nights  rather 
wakeful  than  restless.  Besides  the  treatment  above  mentioned, 
the  patient  had  an  emetic  on  the  first  and  fourth  days,  and  was 
bled  § xxiv.  on  the  third ; opiates  two  or  three  times ; abdomen 
vesicated,  and,  the  cuticle  being  removed,  fomentations  of 
tobacco  were  applied,  but  without  producing  the  specific  effect. 
On  the  last  day,  having  taken  a cathartic  in  the  morning,  he 
was  suddenly  seized  about  ten  o’clock,  A.  M.,  with  an  excruci- 
ating pain  in  the  abdomen  towards  the  back ; the  countenance 
became  livid,  and  there  was  no  pulse  at  wrist,  though  the  heart 
beat  as  strongly  as  before ; had  three  discharges  from  the 
bowels,  with  traces  of  faecal  matter.  Took  forty  drops  of 
laudanum,  and  the  pain  was  relieved  in  about  an  hour  and  a 
half.  At  one  o’clock,  he  wanted  to  pass  his  urine,  and,  the 
catheter  having  been  introduced,  firm  pressure  was  made  over 
the  region  of  the  bladder,  but  without  causing  pain.  Died  at 
two  o’clock,  P.  M. 

On  opening  the  abdomen,  a thin  layer  of  faeces  was  found 
spread  over  the  peritoneal  surface,  but  without  any  appearance 
of  inflammation.  The  diverticulum  arose  from  the  ileum, 
forty-five  inches  from  the  csecal  valve,  and  adhered  firmly  and 
broadly  by  its  blind  extremity  to  the  opposite  side  of  the  same 
intestine,  less  than  an  inch  from  its  origin,  and  forming  a loop 
which  would  readily  admit  the  passage  of  three  fingers. 
Through  this  loop  all  of  the  intestine  between  it  and  the 
caecum,  except  the  last  three  inches,  had  passed.  The  intes- 
tine was  of  a dark  red  color,  and  the  line  of  demarcation 
between  it  and  the  last  three  inches  was  quite  distinct ; the 
strangulation,  however,  was  not  so  complete  but  that  the  intes- 
tine was  readily  withdrawn,  and,  having  been  measured,  was 
carefully  replaced.  The  perforation  was  just  at  the  origin  of 
the  diverticulum,  and  was  about  a line  in  diameter.  The 
intestines  generally  were  very  moderately  distended,  and, 
appearing  healthy  externally,  were  not  opened.  After  the 
specimen  had  been  in  spirit  for  some  days,  it  was  cut  open  to 
the  extent  of  about  an  inch,  and  then  was  found  an  ulceration 
quite  through  the  mucous  coat,  about  half  an  inch  in  diameter, 
and  corresponding  to  the  blind  extremity  of  the  diverticulum, 
but,  whether  recent  or  chronic,  it  was  impossible  to  say.  1841. 


ALIMENTARY  CANAL. 


145 


498.  Strangulation  of  the  intestine  by  the  appendix  cseci.  The 
patient,  a healthy  young  man,  twenty-two  years  of  age,  was 
suddenly  seized  in  the  night  with  violent  colic  pain  in  the 
umbilical  region,  having  previously  had  two  similar,  though 
slight  attacks.  The  pain  continued  to  be  urgent,  but  without 
tenderness  of  the  abdomen,  until  the  last  day ; vomiting  with 
much  retching,  after  the  first,  were  prominent  symptoms ; no 
free  discharge  from  the  bowels,  though  the  most  active  cathartic 
medicines  and  enemata  were  used  daily ; no  constitutional 
affection  at  first,  but  he  soon  began  to  fall  off,  and  died  at  the 
end  of  the  fourth  day.  This  case  occurred  in  the  practice  of 
Dr.  Abner  B.  Wheeler.  On  dissection,  the  extremity  of  the 
appendix  was  found  to  adhere  broadly  to  a portion  of  the  ileum 
twenty-seven  inches  from  its  termination,  and  to  this  extent  the 
intestine  had  become  strangulated.  The  appendix,  when 
recent,  appeared  of  a dark  reddish  brown  color,  as  large  as 
the  little  finger,  and  much  thickened  ; just  at  its  origin  from 
the  csecum  it  seemed  to  be  twisted  upon  itself,  and  as  if  stran- 
gulated, the  transition  from  the  healthy  to  the  thickened  portion 
being  quite  sudden,  as  is  still  seen  in  the  preparation.  The 
intestines  generally  were  very  much  congested,  and  above  the 
strangulation  greatly  distended ; mucous  membrane  of  the 
stomach  of  a bright  scarlet  color  for  the  most  part,  with  a con- 
siderable development  of  the  glands.  1838. 

The  occurrence  of  previous  attacks  in  the  above  case  is  inter- 
esting, as  something  of  the  kind  has  been  noticed  in  several 
other  cases  of  internal  strangulation  which  have  occurred  here ; 
supposing  them  to  have  been  owing  to  a partial  and  temporary 
strangulation  of  the  intestine,  a knowledge  of  their  occurrence 
would  be  an  important  aid  in  the  diagnosis. 

499.  Strangulation  by  the  appendix  cseci,  the  adhesion  of  the 
appendix  being  probably  caused  by  an  old  attack  of  inflamma- 
tion and  perforation,  connected  with  the  presence  of  a foreign 
body.  The  patient  was  a female,  aged  eighty,  and  a patient 
of  Dr.  Edward  Hall.  Twenty-one  years  ago,  according  to 
her  statement,  she  had  an  attack  of  “ inflammation  of  the 
bowels,”  and  from  that  time  had  been  much  subject  to  pain  in 
the  abdomen ; was  also  very  costive.  The  symptoms  of  stran- 
gulation came  on  twelve  days  before  death,  and  were  charac- 

19 


146 


ALIMENTARY  CANAL. 


terized  by  an  incessant,  severe,  colic  pain  in  the  abdomen, 
and  almost  constant  vomiting ; no  dejection,  except  for  a few 
small  scybala  which  were  brought  away  by  enemata;  no 
fever ; refused  all  treatment  until  the  day  before  her  death,  when 
she  found  that  she  must  die. 

On  dissection,  the  abdomen  was  found  quite  distended  and 
tense.  The  large  intestine  throughout  wras  contracted  and 
pale,  the  small  intestine  being  discolored,  congested,  and  much 
distended.  No  peritonitis.  At  the  distance  of  forty  inches 
from  its  lower  extremity,  following  the  course  of  the  small 
intestine,  there  was  an  adhesion  about  over  the  upper  part  of 
the  sacrum,  the  adhesion  being  not  properly  of  the  intestine 
itself,  but  of  the  mesentery  immediately  adjoining,  and  the 
position  of  the  intestine  was  such  that  the  direct  distance  from 
the  lower  end  of  the  ileum  wTas  considerably  less  than  an  inch. 
This  adhesion  was  very  close,  quite  limited,  and  evidently  of 
long  duration;  on  cutting  it  away,  a cavity  was  opened,  about 
half  an  inch  in  diameter,  and  immediately  there  fell  out  a 
whitish  mass,  about  the  size  of  a large  pea,  and  consisting 
apparently  of  indurated  fseces ; the  inner  surface  of  this  cavity 
had  a fistulous  appearance,  and  there  was  a direct  and  free 
communication  between  it  and  the  adjoining  intestine,  the 
opening  being  sufficient  to  admit  a large  probe.  The  appendix 
caeci  was  four  inches  and  a quarter  in  length ; the  first  two 
inches  and  a quarter  were  pervious  and  free,  and,  when  the 
strangulated  intestine  was  withdrawn,  formed  a ring  with  the 
lower  end  of  the  ileum  which  was  large  enough  to  allow  the 
thumb  to  pass  freely  through ; the  rest  of  the  appendix  seemed 
to  be  reduced  to  an  impervious  cord,  and  was  closely  adherent, 
in  the  first  place  to  the  ileum,  which  it  traversed  about  one 
inch  from  its  lower  extremity,  and  next  to  the  mesentery 
between  the  termination  and  the  adherent  portion  of  the  ileum, 
the  extremity  of  the  appendix  corresponding  very  nearly  with 
the  cavity  which  contained  the  foreign  bod}-.  That  portion  of 
the  ileum  which  was  traversed  by  the  appendix  was  as  it  were 
indented,  and  extremely  thin,  as  if  from  some  former  disease, 
perhaps  ulceration.  The  strangulated  portion  of  intestine 
consisted  of  the  whole  forty  inches  between  the  lower  end  of 
the  ileum  and  the  point  of  adhesion,  and,  though  pretty  tightly 
girt,  was  withdrawn  without  any  great  difficulty,  after  it  had 


ALIMENTARY  CANAL. 


147 


been  cut  open  for  examination  and  emptied  of  its  contents. 
The  mucous  membrane  of  the  small  intestine  was  generally- 
congested,  and  just  above  the  strangulation  were  several 
defined  ulcers,  which  were  evidently  the  result  of  acute  dis- 
ease ; above  this  part  the  intestine  was  not  examined.  In  the 
other  organs  there  was  nothing  remarkable,  except  a retrover- 
sion of  the  uterus,  the  fundus  of  the  organ  lying  directly  back 
against  the  rectum ; the  organ  itself  was  crowded  with  fibrous 
tumors,  and  perfectly  knobbed,  though  not  enlarged,  one  of 
the  tumors  being  developed  in  the  broad  ligament,  and  at  some 
distance  from  the  uterus.  In  the  preparation  the  strangulated 
intestine  has  been  again  passed  through  the  yoke  formed  by 
the  appendix,  and  the  relation  of  the  parts,  with  most  of  the 
other  points  above  described,  may  be  distinctly  seen.  April, 
1847. 

500.  Ulceration  of  Peyer’s  glands  in  typhoid  fever.  The  ulcers 
are  perfectly  defined,  with  raised,  rounded  edges,  of  a nearly 
circular  form,  and  varying  from  about  three  to  eight  lines  in 
diameter,  a loose,  flocculent,  ash-colored  slough  hanging  from 
the  base  of  several  of  them.  There  was  also  in  this  case  ex- 
tensive pneumonia,  tending  to  gangrene.  The  patient,  a female, 
thirty-two  years  of  age,  died  at  the  Mass.  Gen.  Hospital, 
October  21st,  1833,  having  been  sick  two  weeks,  with  con- 
siderable diarrhoea,  though  the  local  symptoms  were  mostly  in 
the  head. 

501.  A second  specimen,  in  the  same  jar  with  the  above,  both  of 
them  being  distended  upon  a flat  surface.  The  patches  are 
very  much  larger  than  in  the  first  case,  quite  firm,  and  much 
raised,  as  if  from  some  change  in  the  submucous  cellular 
tissue,  the  edges  being  rounded,  and  in  some  parts  projecting 
over  the  base ; ulceration  extensive,  but  not  so  continuous  over 
the  patches  as  in  the  first  case.  From  a young  man,  who  had 
been  sick  about  three  weeks.  1835. 

502.  Crystals  upon  the  mucous  membrane  of  the  ileum.  From  a 
middle  aged  man,  and  a dissecting-room  subject;  nothing  was 
known  of  his  case  ; but,  from  the  ulceration  of  Peyer’s  glands, 
and  the  discoloration,  there  could  have  been  no  doubt  that  he 


148 


ALIMENTARY  CANAL. 


died  of  typlioid  fever,  and  that  the  disease  had  been  of  some 
weeks  duration.  A few  minute  crystals  were  found  in  the 
thin  faeces  contained  in  the  lower  portion  of  the  ileum,  but 
upon  the  mucous  surface  of  this  intestine  were  very  considerable 
numbers,  which  were  sufficiently  large  to  be  seen  at  some 
distance,  and  though  easily  detached,  were  decidedly  adherent. 
There  were  some  in  the  jejunum  also,  and  upon  the  serous 
surface  there  was  a very  abundant  crystalline  deposit,  which 
will  be  noticed  in  another  place.  In  the  preparation,  a portion 
of  the  ileum  has  been  dried  upon  a black  board,  and  the  crys- 
tals are  thus  distinctly  shown. 

Another  portion  of  the  intestine  having  been  handed  to  Mr. 
Joseph  Peabody,  a student  in  chemistry  in  Dr.  Charles  T. 
Jackson’s  laboratory,  a few  of  the  crystals  were  scraped  off 
and  examined.  A full  report  of  his  examination  was  read  to 
the  Society,  by  which  it  appears  that  the  crystals,  which  he 
describes  as  translucent  and  prismatic,  consist  mainly  of  the 
phosphate  of  lime,  with  some  other  acid,  probably  the  sulphuric, 
but  without  any  trace  of  magnesia.  1847. 

Dr.  J.  B.  S.  Jackson. 

503.  Acute  inflammation  of  Peyer’s  glands ; from  a case  of  dys- 
entery. (See  No.  514.) 

504.  A portion  of  dried  intestine,  showing  an  increased  vascularity 
in  Peyer’s  glands.  The  patient  was  twenty  five  years  of  age, 
had  had  sore  throat,  with  symptoms  of  disordered  stomach  for 
about  two  days,  when  he  was  taken  with  active  delirium,  and 
other  marks  of  congestion  of  the  brain,  and  died  in  about 
thirty  hours ; had  been  under  the  care  of  Dr.  George  Hay- 
ward. Many  of  the  patches  about  the  middle  of  the  intestine 
were  thickened,  softened,  and  of  a dull  red  color,  the  sub- 
mucous cellular  tissue  being  more  red  than  the  patch  itself ; 
higher  up  they  were  thick  and  soft,  but  scarcely  red ; the  folli- 
cles were  generally  quite  distinct,  especially  in  the  patches  at 
the  lower  end  of  the  ileum,  and  in  those  which  were  red  they 
appeared  to  be  filled  with  a whitish  secretion.  There  was  no 
other  disease  of  any  consequence,  the  brain  and  membranes 
being  perfectly  healthy.  It  was  thought  that  this  might  possi- 
bly have  been  a case  of  scarlatina.  1837, 


ALIMENTARY  CANAL. 


149 


505.  A portion  of  membrane,  of  a perfectly  tubular  form,  and 
measuring  more  than  four  feet  and  a half  in  length.  It  was 
discharged  from  the  intestines  of  a man  who  was  convalescent 
from  fever,  and  was  sent  to  the  Society  by  Dr.  A.  L.  Peirson, 
of  Salem,  as  a specimen  of  false  membrane.  From  the  firm- 
ness of  the  membrane,  however,  and  from  the  appearance  as 
of  muscular  fibres  and  of  blood-vessels  upon  it,  it  has  been 
regarded  by  some  who  have  examined  it  as  the  mucous  mem- 
brane itself  which  has  been  detached  with  more  or  less  of  the 
subjacent  tissue. 

506.  Perforation  of  the  duodenum  through  a small,  chronic,  solitary 
ulcer,  about  one-third  of  an  inch  from  the  pylorus.  From  a 
man,  twenty-six  years  of  age,  who  had  suffered  much  from 
dyspepsia;  fatal  symptoms  came  on  twenty-six  hours  before 
death,  and,  on  dissection,  there  was  found,  as  usual,  acute 
peritonitis  ; a patient  of  Dr.  Ezra  Palmer. 

Several  other  cases  have  been  observed  here,  showing  the 
resemblance  between  the  chronic  ulcer  of  the  duodenum  and 
that  of  the  stomach  ; in  two  of  them,  besides  the  above,  perfo- 
ration occurred,  and  in  another  there  had  been  several  attacks 
of  active  hsematemesis  a few  months  before  death. 

507.  Cancerous  disease,  with  great  dilatation  of  the  small  intestine. 
The  patient,  who  had  been  under  the  care  of  Dr.  Charles  G. 
Putnam,  was  a healthy  little  girl,  six  years  of  age,  and  began 
to  complain  of  pain  in  the  abdomen  in  December,  1839,  lasting 
but  for  a few  minutes,  and  recurring  once  or  twice  a week  for 
about  six  weeks  ; it  then  left  her,  and  did  not  afterwards  return. 
In  April,  1840,  she  had  severe  pneumonia,  from  which  she 
entirely  recovered.  In  June,  she  had  a hot  skin,  quick  respi- 
ration, restless  nights,  and  an  enlargement  of  the  abdomen, 
but  without  pain  or  tenderness  on  exercise  or  on  pressure ; her 
appetite  was  pretty  good,  but  she  would  soon  leave  the  table, 
from  a sense  of  fulness.  In  August,  a distinct  tumor  was  felt 
in  the  right  iliac  region ; this  always  remained,  and  was  found 
after  death  to  be  a diseased  ovary ; the  specimen  is  in  the 
Cabinet.  Towards  the  last,  she  became  greatly  emaciated, 
with  almost  constant  perspiration,  and  quick  breathing,  but 
retained  considerable  strength,  and  rested  better.  For  some 


150 


ALIMENTARY  CANAL. 


months  before  death  the  bowels  were  irregular,  with  a tendency 
to  diarrhoea.  Never  any  symptoms  referred  to  the  kidneys, 
though  these  organs  were  greatly  diseased,  one  of  them  being 
preserved  in  the  Cabinet.  Died  rather  suddenly,  November 
23d,  1840. 

On  dissection,  the  omentum,  mesentery,  and  inner  surface 
of  the  abdominal  parietes  generally  were  loaded  with  a whitish, 
homogeneous,  lardaceous  tissue,  almost  every  trace  of  fat 
having  been  absorbed  from  the  integuments;  the  same,  though 
less  in  amount,  was  found  about  the  pericardium  and  heart; 
some  serous  effusion ; ovaries  and  kidneys  diseased,  as  will  be 
hereafter  described.  About  twenty  inches  from  the  caecum 
the  small  intestine  dilated  abruptly  into  a rounded  sac,  capable 
of  holding  twenty  ounces  or  more,  and  filled  with  soft  faeces 
and  gas ; the  parietes  were  sufficiently  thick,  and  seemed  to 
consist  mostly  of  the  morbid  deposit,  which  was  everywhere 
so  abundant ; inner  surface  rough  as  from  ulceration.  This 
sac  was  formed  opposite  to  the  mesentery,  and  the  outlet  from 
it  being  at  the  distance  of  only  two  inches  from  the  entrance, 
the  analogy  to  a form  of  aneurism,  as  sometimes  seen  in  the 
aorta,  was  at  once  suggested.  The  intestines  otherwise  were 
sufficiently  healthy. 

In  June,  1846,  a case  occurred  in  the  practice  of  Dr.  Henry 
G.  Clark,  which  so  strikingly  resembled  the  one  just  related, 
in  its  most  remarkable  points,  that  it  should  be  mentioned  in 
connection  with  it.  The  patient  was  a delicate  little  girl,  four 
years  old,  and  was  not  thought  to  be  sick  till  about  three  weeks 
before  her  death,  when  she  began  to  lose  flesh,  strength,  and 
color,  but  without  any  very  marked  local  symptoms;  some 
vomiting  at  first,  from  an  especial  cause,  but  not  afterwards, 
the  stomach  and  bowels  being  sufficiently  well.  The  abdomen 
was  tumid,  but  without  pain  or  tenderness.  About  two  weeks 
before  death,  Dr.  C.  felt  two  large,  defined,  quite  movable 
tumors,  one  in  each  iliac  fossa,  and  directed  upwards  and  out- 
wards ; these  were  found,  on  dissection,  to  be  diseased  ovaries, 
one  of  them  being  half  as  large  as  the  fist,  and  the  other  half 
as  large  again  as  the  fist.  There  was  also  in  the  upper  part 
of  the  abdomen,  upon  the  right  side,  a large  solid  tumor,  which 
was  found  after  death  to  be  connected  with  an  aneurismal-like 
dilatation  of  the  small  intestine  ; the  dilatation  was  perfectly 


ALIMENTARY  CANAL. 


151 


abrupt,  situated  about  three  feet  from  the  lower  end  of  the 
ileum,  had  a regular,  rounded  form,  would  hold  about  a pint, 
and  was  partly  filled  with  faeces ; the  parietes  of  the  sac  con- 
sisted mainly  of  the  lardaceous  deposit,  and  the  whole  abdomen, 
as  in  the  first  case,  was  loaded  with  the  same,  but  with  some 
intermixture  of  the  encephaloid. 

vi.  Large  Intestine. 

508.  Hernia  of  the  mucous  membrane  of  the  large  intestine,  from 
a lady  who  died  from  an  encephaloid  disease  of  the  arch  of 
the  colon.  The  sacculi  were  twelve  or  fifteen  in  number, 
situated  between  the  muscular  bands,  and  between  the  disease 
and  the  ascending  colon ; they  were  quite  thin,  and  from  two 
to  four  lines  in  diameter,  though  considerably  smaller  at  their 
orifices.  A dried  specimen.  This  affection  I have  met  with 
in  the  large  intestine  in  three  other  cases,  and  in  each  of  them 
it  was  about  the  sigmoid  flexure ; one  of  the  patients  had  had 
chronic  ulceration  of  the  stomach ; 'the  other  two,  as  in  the 
above  case,  had  cancer  of  the  large  intestine,  but  above  the 
seat  of  the  herniae,  and  one  of  them  died  at  last  from  peritonitis 
induced  by  a rupture  of  one  of  the  sacculi.  1847. 

Dr.  J.  B.  S.  Jackson. 

509.  Intussusception  of  the  rectum.  The  intestine  is  completely 
doubled  upon  itself,  and  protruded  about  half  an  inch  from  the 
anus.  From  an  old  woman,  who  had  been  subject  to  haemor- 
rhage from  the  bowels  for  a year  previous  to  her  death.  The 
fatal  attack  lasted  ten  days;  came  on  with  great  and  constant 
haemorrhage,  distress,  and  a sense  of  bearing  down  as  in  labor  ; 
there  was  no  vomiting  until  the  last  four  or  five  days,  and  no 
discharge  from  the  bowels,  except  for  a single,  small,  scybalous 
mass,  enemata  being  always  immediately  rejected.  1839. 

Dr.  George  C.  Shattuck. 

510.  A portion  of  small  and  large  intestine,  showing  an  ulcer  in 
this  last,  which  was  the  source  of  fatal  haemorrhage ; from  a 
case  of  typhoid  fever.  The  patient  was  a young  lady,  fourteen 
years  of  age,  who  had  had  the  disease  for  about  sixteen  days, 
but  without  diarrhoea,  the  symptoms  being  so  mild  that  her 


152 


ALIMENTARY  .CANAL. 


physician,  Dr.  Hayward,  was  not  sent  for  until  three  hours 
before  death,  when  the  haemorrhage  commenced.  During 
these  three  hours  she  had  four  or  five  discharges,  each  of  them 
consisting  of  about  a gill  of  florid  blood,  besides  an  almost 
constant  oozing  from  the  bowels  of  the  same.  On  dissection, 
the  usual  appearances  were  found  in  Peyer’s  glands,  the 
mesenteric  glands,  and  the  spleen.  The  large  intestine  con- 
tained gviij.  or  §x.  of  fresh  liquid  blood,  some  having  passed 
up  into  the  ileum.  In  the  caecum  and  ascending  colon  were 
twelve  or  fifteen  spots  of  recent  disease,  some  of  them  only 
being  ulcerated  ; one  of  the  deepest  ulcers,  situated  very  near 
to  the  caecal  valve,  and  measuring  one-third  of  an  inch  in  diam- 
eter, was  shown  to  be  the  source  of  the  haemorrhage  by  having 
a dark  red  coagulum  hanging  from  its  base.  1837. 

511.  Acute  inflammation,  with  gangrene  and  perforation  of  the 
appendix  caeci ; no  foreign  body  found.  About  this  part,  a 
large,  circumscribed  abscess  had  formed,  but  the  peritoneum 
generally  was  healthy.  The  patient,  a lad  ten  years  of  age, 
died  rather  suddenly,  in  convulsions,  on  the  fifth  day  of  the 
disease.  The  pain  in  the  abdomen  was  never  severe ; there  was 
very  little  vomiting,  and  the  bowels  acted  from  medicine.  1838. 

512.  A case  similar  to  the  last,  but  in  which  a foreign  body  was 
found  in  the  appendix  cseci.  The  patient,  a stout,  muscular 
man,  twenty-two  years  of  age,  had  eaten  a great  number  of 
pea-nuts  in  the  evening,  and  was  attacked  in  the  night  with 
vomiting;  this  ceased  on  the  following  day,  but  he  felt  indis- 
posed, and  kept  the  house ; on  the  third  day  he  did  some  work. 
On  the  fourth  day  pain  in  the  abdomen  came  on,  and  was 
constant  until  his  death,  increasing  every  few  minutes,  and 
darting  so  as  to  make  him  ciy  out.  The  whole  abdomen  was 
very  tender  and  tense,  but  not  swollen  until  towards  the  close 
of  the  disease ; vomited  two  or  three  times  daily,  without 
retching,  but  as  if  from  over-distention  of  the  stomach. 
Bowels  open  on  the  day  before  the  attack,  but  never  freely 
after  that  time,  though  the  most  active  medicines  were  used, 
this  obstruction  being  regarded  as  the  most  important  point  in 
the  case,  and  towards  which  all  the  treatment  was  directed. 
Pulse  and  skin  natural,  though  there  had  been  chills  early  in 


ALIMENTARY  CANAL. 


153 


the  attack.  Duration  of  the  disease  one  week.  This  case 
occurred  in  the  practice  of  Dr.  Daniel  T.  Coit. 

On  dissection,  there  was  found  a general  though  slight  peri- 
tonitis, and  a small,  circumscribed  abscess  about  the  appendix 
cseci;  this  last  generally  exists  in  these  cases,  and  here  it  was 
formed  by  the  appendix  on  one  side  and  by  a fold  of  small 
intestine  on  the  other,  the  cavity  containing  about  3ij.  of  thin 
pus.  Outer  surface  of  the  appendix,  to  the  extent  of  one-third 
of  an  inch  or  more,  quite  soft,  blackish,  and  evidently  gangre- 
nous, there  being  some  discoloration  of  the  intestine  opposite ; 
inner  surface  ulcerated,  but  not  gangrenous,  the  cavity  con- 
taining pus  like  that  in  the  abscess,  and  also  a pea-nut,  which 
was  very  little,  if  at  all  changed ; perforation  through  into  the 
abscess  two  lines  or  more  in  diameter.  The  small  intestine 
was  much  distended  with  gas,  and  a thin,  yellow  liquid,  and 
was  greatly  congested  if  not  inflamed,  the  mesenteric  glands 
being  affected  as  in  typhoid  fever.  Large  intestine  rather 
contracted.  In  this  preparation  and  the  last  the  appendix  only 
has  been  preserved,  and  the  two  are  contained  in  the  same  jar. 

513.  Calculus  from  the  appendix  cseci ; a similar  case  to  the  last, 
and  occurring  in  the  practice  of  Dr.  J.  Bigelow.  The  patient 
was  a healthy  female  domestic,  and  died  on  the  fifth  day  of 
the  disease,  the  chief  symptoms  having  been  colic  pain, 
with  tenderness  of  the  abdomen,  nausea,  and  vomiting,  and,  for 
a part  of  the  time,  obstinate  constipation.  In  this,  as  in  seve- 
ral other  cases  that  have  occurred  here,  the  fatal  attack  came 
on  after  an  inordinately  hearty,  or  very  unusual  meal.  The 
calculus,  in  this  case,  is  pear-shaped,  and  seven  and  a half 
lines  in  length,  fawn-colored,  quite  smooth,  and  moderately 
hard ; when  recent,  it  was  thickly  coated  with  a soft  substance, 
having  no  appearance  of  fasces,  but  seeming  to  consist  of  the 
same  material  not  yet  hardened.  There  was  a second  smaller 
calculus,  which,  on  being  analyzed  by  Dr.  M.  Gay,  was  found 
to  consist  of  the  phosphate  of  lime  and  magnesia,  with  some 
animal  matter,  and,  on  breaking  it  open,  there  was  found  in  the 
centre  a dark  nucleus,  the  nature  of  which  was  not  ascer- 
tained ; this  is  also  preserved.  The  appendix  also  contained 
some  of  the  soft  substance  above  alluded  to,  with  gritty  matter 
in  its  centre,  being,  as  it  were,  a third  calculus  in  the  earliest 
20 


154 


ALIMENTARY  CANAL. 


period  of  its  formation.  The  general  condition  of  the  appendix 
and  of  the  peritoneal  cavity  was  very  nearly  the  same  as  in  the 
last  case.  There  was,  however,  less  inflammation  of  the 
appendix,  the  gangrene  seeming  to  be  almost  a primary  change, 
and  the  same  was  observed  in  some  of  the  other  cases  above 
referred  to.  The  lower  end  of  the  ileum  formed  the  opposite 
wall  of  the  small  abscess  about  the  appendix,  as  if  the  object 
of  nature  had  been  to  discharge  the  foreign  body  into  that 
portion  of  the  intestine.  The  opening  of  the  appendix  from 
the  caecum  was  so  small  as  hardly  to  admit  the  head  of  a pin. 

514.  Intestine  from  a case  of  acute  dysentery.  The  large  intestine 
was  throughout  completely  covered  with  lymph,  which  was 
easily  scraped  off,  and  showed  the  mucous  membrane  beneath 
of  a bright  red  color,  thickened,  and  soft.  Throughout  the 
lower  two-thirds  of  the  small  intestine  Peyer’s  glands  were 
similarly,  though  rather  less  affected.  Portions  of  the  large 
and  small  intestine  are  preserved  in  the  same  jar.  The  patient, 
an  infant  aged  fourteen  months,  died  on  the  fifth  day,  having 
suffered  from  the  disease  in  a very  severe  form.  The  case 
occurred  in  the  month  of  March,  and  in  the  practice  of  the  late 
Dr.  Charles  T.  Hildreth ; in  the  course  of  a few  weeks  there 
were  four  other  cases  of  this  disease  in  the  same  house,  and  the 
mother  died  of  it  on  the  day  after  the  infant  was  attacked.  1834. 

515.  Portions  of  the  large  and  small  intestine  contracted  and  thick- 
ened, the  mucous  membrane  being  rough,  covered  with  lymph, 
and  of  a dark  greenish  color,  as  if  stained  by  the  contents ; 
the  ileum  is  also  seen  to  be  marked  by  strong  transverse  rugae. 
The  disease  was  quite  extensive,  and  the  patient,  a healthy 
little  girl,  eight  years  of  age,  died  after  an  illness  of  a week’s 
duration,  with  symptoms  much  resembling  those  of  internal 
strangulation.  She  had  been  under  the  care  of  Dr.  Minot  C. 
Weld,  of  Jamaica  Plains.  1841. 

516.  A portion  of  large  intestine,  showing  numerous,  small  ulcera- 
tions. 

517.  A portion  of  the  sigmoid  flexure,  showing  a large,  deep,  and 
broad  ulcer,  which  involves  the  whole  circumference  of  the 


ALIMENTARY  CANAL. 


155 


intestine.  From  a boy,  aged  four  years,  affected  with  general 
tuberculous  disease,  and  for  the  last  five  months,  with  diarrhoea. 

518.  Stricture  of  the  intestine  at  the  junction  of  the  arch  and  the 
descending  colon.  The  patient,  a female,  aged  twenty-nine, 
had  been  sick  about  four  weeks;  the  symptoms  were  very 
urgent,  and  were  mainly  a colic  pain  in  the  left  side  of  the 
abdomen,  vomiting,  and  constipation,  a great  deal  of  cathartic 
medicine  having  been  given,  besides  enemata,  from  which  she 
had  occasionally  a small  discharge.  The  diseased  portion  was 
about  half  an  inch  in  extent,  felt  as  dense  externally  as  a 
scirrhous  pylorus,  and  was  so  contracted  that  water  poured  in 
above,  after  the  parts  had  been  removed,  would  not  run  through. 
Having  been  cut  open,  the  transverse  diameter  at  the  seat  of 
disease  was  found  to  be  two-thirds  of  an  inch ; the  induration 
affected  about  one-half  of  the  calibre  of  the  intestine,  and 
upon  the  inner  surface  was  a superficial,  ill-defined,  ulceration 
or  abrasion,  such  as  is  often  found  in  scirrhus  of  the  stomach, 
the  comparatively  healthy  portion,  which  was  the  part  cut 
through,  being  thickened,  though  not  indurated.  Above  the 
contracted  part  the  intestine  was  much  dilated,  and  there  was 
acute  inflammation,  as  shown  by  numerous  small,  red,  deep 
ulcerations,  one  of  which,  two  inches  above  the  seat  of  the 
stricture,  was  perforated,  and  gave  rise  to  peritonitis,  which 
was  the  immediate  cause  of  death.  Below  the  stricture  the 
intestine  was  contracted,  and  quite  healthy,  as  were  the  organs 
generally.  This  case,  which  was  most  perfectly  diagnosed, 
occurred  in  the  practice  of  the  late  Dr.  Charles  T.  Hildreth. 
1837. 

519.  Cancer  of  the  rectum.  The  patient,  a female,  about  thirty 
years  of  age,  had  had  no  discharge  from  the  bowels  for  two  or 
three  weeks  before  her  death,  and  died  from  the  effects  of  the 
obstruction.  The  disease  commences  two  inches  from  the 
anus,  and  extends  upwards  from  three  to  four  inches,  being 
sufficiently  well  defined.  All  of  the  tissues  are  more  or  less 
thickened  and  otherwise  diseased,  but  particularly  the  muscular 
coat,  which,  at  one  part  measures  four  and  a half  lines,  and 
has  throughout  the  well  marked  character  of  scirrhus  ; the 
cellular  membrane,  also,  between  the  intestine  and  the  sacrum, 


156 


ALIMENTARY  CANAL. 


is  indurated,  and  with  the  fat  forms  a solid  mass  an  inch  in 
thickness.  The  passage  through  the  diseased  portion  is  irreg- 
ular, and  much  contracted,  and  upon  the  inner  surface  there  is 
an  ill  defined,  cancerous  looking  ulceration,  which  has  pene- 
trated in  some  parts  entirely  through  the  parietes  of  the  intes- 
tine. Above  the  diseased  part  the  rectum  is  dilated,  and  the 
muscular  coat  thick  and  fleshy.  Just  below  the  seat  of  the 
disease,  but  in  a perfectly  healthy  part  of  the  intestine,  there  is 
a clean,  longitudinal  slit,  five  lines  in  length,  and  opening  into  a 
considerable  cavity  in  the  recto-vaginal  parietes ; from  this  last 
there  is  an  opening,  between  two  and  three  lines  in  diameter, 
into  the  upper  part  of  the  vagina,  and  from  this  there  hangs 
out  a slough  of  cellular  membrane,  about  an  inch  in  length; 
the  uterus  was  healthy,  and  has  been  cut  away  in  the  prepara- 
tion. The  lower  portion  of  intestine  is  seen  to  be  otherwise 
healthy,  except  for  enlarged  veins  and  haemorrhoids.  The 
specimen  was  sent  to  Dr.  Edward  Reynolds  by  Dr.  Joel  Bur- 
nett, of  Southborough.  1838. 

520.  Disease  of  the  rectum,  probably  malignant,  but  differing 
entirely  from  the  usual  forms  of  carcinoma.  The  patient,  a 
gentleman,  forty-five  years  of  age,  began  to  have  symptoms  of 
the  disease  four  years  before  death ; pain  low  in  the  back,  and 
difficulty  in  evacuating  the  bowels,  with  discharges  of  blood, 
which  were  sometimes  profuse,  the  pain  increasing  towards 
the  last  so  as  to  require  very  large  doses  of  opium.  Constipa- 
tion also  was  a very  urgent  symptom,  six  grains  of  the  extract 
of  stramonium,  as  a suppository,  producing  the  most  relaxing 
effect,  which  would  last  for  many  hours,  but  without  evacuating 
the  bowels.  The  skin  was  always  sallow ; the  stomach  never 
became  irritable,  and  the  appetite  continued  to  the  last,  though 
the  emaciation  was  very  great.  On  dissection,  the  large  intes- 
tine was  enormously  distended,  but  was  internally  healthy, 
except  in  the  rectum,  where  the  disease  began,  two  inches 
above  the  anus,  and  extended  upwards  four  inches ; it  affected 
the  whole  circumference,  and  seemed  to  consist  of  soft,  fun- 
gous, cauliflower  excrescences,  which  obstructed  the  intestine 
as  completely  as  it  would  have  been  by  a soft  sponge.  The 
disease  is  more  advanced  inferiorly,  and  is  there  well  defined, 
but  is  rather  less  so  above ; on  the  cut  edge  there  is  no  distinction 


ALIMENTARY  CANAL. 


157 


of  tissues  now  to  be  seen,  neither  is  there  any  appearance  of 
scirrhus  nor  of  the  encephaloid  deposit.  The  preparation, 
however,  had  been  in  spirit  for  some  time  when  examined, 
a figure  of  the  specimen  with  an  account  of  the  case  having 
been  published  by  Dr.  A.  L.  Peirson,  of  Salem,  in  the  New 
York  Med.  and  Phys.  Journal  for  1825,  (Yol.  iv.  No.  iii.) 

521.  Fistula  in  ano,  occurring  in  the  last  stages  of  phthisis.  The 
patient,  a man,  forty-eight  years  of  age,  died  at  the  Mass.  Gen. 
Hospital  in  October,  1838,  having  been  sick  nearly  eighteen 
months.  Three  weeks  before  death  an  abscess  formed,  which 
soon  burst,  and  has  left  two  separate  openings  just  outside  of 
the  verge  of  the  anus.  The  fistulse  within  also  appear  to  be 
separate,  extending  upwards  nearly  two  inches,  and  not  com- 
municating with  the  rectum.  The  cavity  of  another  abscess, 
also,  which  was  opened  in  the  course  of  the  dissection,  is  seen 
just  above  the  anus. 

vn.  Foreign  Substances. 

522.  A Snail’s  shell,  showing  the  action  of  the  gastric  juice ; from 
the  stomach  of  a frog. 

523.  The  gizzard  of  a pigeon,  transfixed  by  a pin. 

524.  Hair-ball  from  a Cow’s  stomach.  In  form,  color,  and  size  it 
resembles  a large  Ostrich’s  egg,  being  smooth  and  polished  on 
the  surface.  Sixteen  others,  of  various  sizes,  were  taken  from 
the  same  animal. 

Dr.  Charles  G.  Page , of  Washington. 

525.  A second  specimen,  from  another  subject ; it  is  about  the  size 
of  an  orange,  somewhat  flattened,  and  of  a dark  brown  color, 
but  perfectly  smooth,  and,  as  it  were,  glazed  upon  the  surface. 

Boston  Society  of  Natural  History. 

526.  “ Two  hair-balls  from  the  stomach  of  a Hog,  which  had  been 
fed  on  the  fleshing  from  a tanner’s  yard.”  One  is  about  the 
size  of  a hen’s  egg,  and  the  other  about  as  large  as  the  double 
fist;  they  differ  entirely  from  the  two  specimens  above 


158 


ALIMENTARY  CANAL. 


described,  in  their  form,  general  appearance,  and  composition, 
being  made  up,  not  of  hair  alone,  but  of  a mixture  of  mud  and 
hair.  1840.  Dr.  Willard  Adams , of  Woburn. 

527.  Shot  from  the  appendix  cseci.  The  patient,  an  old  gentleman, 
eighty-eight  years  of  age,  died  of  chronic  disease,  never  having 
had  any  symptoms  of  trouble  about  the  appendix ; neither  was 
this  organ  found  to  be  diseased,  nor  in  any  way  remarkable, 
except  that  it  was  unusually  long.  The  shot,  one  hundred  and 
twenty-two  in  number,  are  of  the  size  commonly  known  as 
robin-shot,  and  several  of  them  are  flattened,  having  facettes 
like  prostatic  calculi.  Their  presence  is  explained  by  the  fact 
that  the  old  gentleman,  who  was  a great  epicure,  was  in  the 
habit  of  indulging  very  freely  in  the  use  of  wild  game. 

Dr.  C.  C.  Holmes,  of  Dorchester. 

528.  A Penknife,  which  was  swallowed  by  a child  between  three  and 

four  years  of 
age,  and  pas- 
sed from  the 

bowels  after  the  expiration  of  fifty-one  hours,  the  child  in  the 
mean  time,  as  the  father  stated,  “ playing  about  as  usual,  and 
not  minding  it  in  the  least.”  The  knife,  being  a very  small 
one,  has  been  represented,  in  the  adjoining  figure,  of  the  full 
size ; the  blade  is  dull,  but  was  open  at  the  time  that  it  was 
passed.  1838. 

Dr.  George  C.  Shattuck. 

529.  A block  of  lead  nearly  an  inch  in  length,  and  one-fourth  of  an 
inch  in  diameter,  with  a nail  driven  into 
it;  swallowed  by  a child,  three  or  four 
years  old,  and  passed  from  the  bowels  in 
about  as  many  days,  causing  meanwhile 
no  inconvenience ; it  is  intended  to  be  rep- 
resented in  the  adjoining  figure  of  full  size. 

1845.  Dr.  Z.  B.  Adams. 

530.  A silver  pencil-case,  three  inches  and  a quarter  in  length, 
which  was  swallowed  by  a young  man,  and  passed  on  the  fifth 
day,  causing  no  trouble  until  it  reached  the  anus,  where  it  met 


ALIMENTARY  CANAL. 


159 


with  some  obstruction,  but  was  removed  without  difficulty. 
1841.  Dr.  D.  H.  Stover. 

531.  Small  pieces  of  glass  swallowed,  and  passed  by  stool ; from 
an  insane  patient,  who  entered  the  McLean  Asylum  in  Febru- 
ary, 1828,  and  was  discharged  w'ell  in  about  eight  months;  he 
was  twenty-one  years  of  age,  despondent,  and  quite  suicidal. 
July  8th,  he  swallowed  some  pieces  of  a mirror ; one  piece 
passed  on  the  10th,  and  the  rest  on  the  12th  and  13th.  August 
22d,  whilst  walking  in  the  yard,  he  found  and  swallowed  more 
glass,  and  on  the  24th,  discharged  several  large  and  many 
small  pieces.  They  are  preserved  in  separate  jars,  and  would 
altogether  about  fill  a table-spoon.  November,  1846. 

532.  A large  piece  of  cotton  cloth  and  a piece  of  blanket,  which 
were  swallowed,  and  passed  by  stool.  The  patient  was  twenty- 
five  years  of  age,  entered  the  McLean  Asylum  in  the  year 
1822,  and  died  on  the  13th  of  September,  1823.  In  December, 
he  had  “ pieces  of  cloth,  buttons,  &c.  pass  off  by  stool ; ” on 
the  11th  of  June,  he  vomited  a piece  of  blanket,  having  been 
sick  through  the  day,  and  on  the  18th,  the  record  is  as  follows : 
“at  stool  has  passed  pieces  of  woollen  blankets,  and  large 
pieces  of  his  shirt,  which  he  probably  swallowed  some  days 
since,  and  have  been  probably  the  cause  of  his  distress  and 
sickness.  One  piece  swallowed  was  two  and  a half  feet  in 
length  and  from  four  to  ten  inches  in  width  — another  narrow, 
but  nearly  as  long.” 

The  piece  of  cotton,  which  has  been  preserved,  is  irregular 
in  its  form,  and  consists  of  one  nearly  square  piece,  which 
measures  twelve  by  fourteen  inches,  and  an  appendage  which 
measures  seventeen  inches  in  length,  and  from  four  to  six  in 
width.  The  piece  of  blanket  is  equal  to  about  four  inches 
square.  November,  1846. 

533.  A glass  jar,  containing  a variety  of  articles  which  had  been 
swallowed  at  different  times,  and  passed  by  stool ; they  consist 
of  nails,  screws,  pieces  of  pewter  spoons,  &c.,  and  weigh 
altogether  half  a pound.  The  patient  was  a sailor,  thirty-three 
years  of  age,  and  became  insane  at  sea ; entered  the  McLean 
Asylum  February  29th,  1828,  and  was  discharged  relieved  in 


160 


ORGANS  ACCESSORY  TO 


about  seven  months.  On  the  day  of  his  admission  he  had 
swallowed  a thimble,  and  on  the  following  day  he  took  medi- 
cine, and  discharged  the  “ thimble,  a large  wrought  board-nail, 
a horn  pick,  and  pieces  of  cloth,  thread,  &c.”  Three  of  the 
nails  measure,  each  of  them,  nearly  three  inches  in  length ; 
the  “ horn-pick  ” is  rather  longer  and  has  a very  sharp  point. 
November,  1846. 


VIII.  ORGANS  ACCESSORY  TO  THE  ALI- 
MENTARY CANAL. 


i.  Teeth. 

534.  The  upper  maxillary  bones  of  a child,  showing  the  two  sets 

of  teeth.  Dr.  Winslow  Lewis. 

535.  The  molar  tooth  of  a Cow,  ground  down  and  polished,  to  show 

its  structure.  Dr.  Jeffries  Wyman. 

536.  An  upper  maxillary  bone,  showing  the  projection  of  the  dens 
sapientise  into  the  antrum. 

537.  Cranium  of  a Marmot,  or  Woodchuck,  ( Arctomys  monax ,) 
showing  a preternatural  growth  of  the  incisor  teeth,  which  is 
observed  in  the  rodentia  when  the  antagonizing  incisors  are 
lost  or  are  diverted  from  their  usual  direction.  The  lower 
jaw  is  wanting.  The  left  incisor  makes  somewhat  more  than 
a complete  circle,  its  point  having  penetrated  the  alveolar  edge 
of  the  upper  maxillary  bone  upon  the  right  side,  and  appearing 
beneath  the  root  of  the  incisor  tooth  of  that  side ; this  right 
incisor  may  have  been  equally  developed,  but  appears  to  have 
been  accidentally  broken.  The  perforation  in  the  superior 
maxillary  bone  by  the  left  incisor  is  remarkably  smooth,  and  as 
perfectly  free  from  any  appearance  of  disease,  as  if  it  were  a 
natural  opening. 

538.  A second  specimen,  similar  to  the  last.  The  lower  jaw  has 


THE  ALIMENTARY  CANAL. 


161 


been  preserved  in  this  case,  and  the  upper  and  lower  incisors 
are  seen  to  deviate  much  from  their  usual  direction  and  to  be 
much  elongated.  1847. 

Boston  Society  of  Natural  History. 

539.  A tooth  almost  buried  by  an  incrustation  of  tartar,  the  whole 
forming  a mass  about  as  large  as  the  top  of  the  thumb. 

Dr.  William  E.  Coale. 

540.  A jar  filled  with  teeth  in  various  states  of  disease. 

ix.  Mesentery  and  Peritoneum. 

541.  An  abscess  in  the  mesentery,  opening  into  the  cavity  of  the 

intestine.  From  a patient  of  the  late  Dr.  Charles  T.  Hildreth; 
a little  girl,  seven  years  of  age,  who  died  with  the  usual  symp- 
toms of  phthisis,  the  bowels  having  been  generally  rather  loose, 
and  very  much  so  when  she  took  animal  food.  The  mesenteric 
disease  consists  of  a mass  of  suppurating  glands,  altogether 
two  inches  or  more  in  diameter.  Connected  with  this  mass 
are  two  folds  of  small  intestine,  which  adhere  together  exter- 
nally ; upon  the  inside  of  each  of  these  folds,  and  at  the  point 
of  adhesion,  is  an  old,  defined  ulcer,  which  extends  around  the 
entire  circumference  of  the  intestine,  and  through  these  ulcers 
there  is  a common  opening  into  the  cavity  of  the  abscess. 
The  intestine  was  otherwise  healthy,  except  for  a trace  of 
tuberculous  disease  in  Peyer’s  glands.  Lungs  &c.  tubercu- 
lous. This  mode  of  termination  of  mesenteric  disease  must 
be  quite  rare  ; and  it  is  remarkable  that  in  the  same  subject, 
an  abscess  in  the  situation  of  the  bronchial  glands  was  found 
to  communicate  with  the  oesophagus.  (No.  447.)  1838. 

542.  Mesenteric  glands  ossified,  from  different  subjects,  and  varying 
in  size  from  a pea  to  that  of  a pullet’s  egg. 

543.  An  ossified  mesenteric  tumor;  sawed  open  and  dried.  It  was 
about  the  size  of  the  double  fist,  when  recent,  and  was,  in 
structure,  partly  fibro-cartilaginous,  but  for  the  most  part  ossi- 
fied. At  one  extremity  is  seen  the  distinct  outline  as  of  an 
ossified,  mesenteric  gland.  The  small  intestine  was  deeply 

21 


162 


ORGANS  ACCESSORY  TO 


imbedded  in  the  tumor,  and,  having  been  cut  open,  there  was 
found  hanging,  as  it  were  from  its  interior,  and  by  a small 
pedicle,  a rounded  tumor  about  the  size  of  an  English  walnut; 
this  last  did  not  appear  to  be  ossified,  and  is  of  course  much 
shrunk  in  the  preparation.  From  a patient  of  Dr.  John  Ware  ; 
a boy  nine  years  of  age,  who  had  been  sick  for  about  a year, 
had  had  a hard,  knobbed  tumor  in  the  abdomen,  with  pain  in 
evacuating  the  bowels,  and  extreme  emaciation.  1832. 

544.  A portion  of  the  abdominal  parietes,  showing  a regular, 
rounded,  pendulous  mass  of  encephaloid  disease,  about  the 
size  of  an  English  walnut,  and  growing  from  the  peritoneal 
surface.  The  cavity  of  the  abdomen  was  filled  with  similar 
masses,  varying  from  the  size  of  a pin’s  head  to  that  of  the 
fist.  They  were  generally  encephaloid  in  their  structure,  with 
more  or  less  effused  blood ; the  smallest,  however,  appeared 
semi-cartilaginous,  and  the  largest  were  decidedly  fibrous.  A 
small  mass  was  found  upon  the  interior  of  one  of  the  Fallopian 
tubes,  and  there  was  some  appearance  of  disease  in  one  of  the 
ovaries,  but  otherwise  the  organs  of  the  abdomen  were  not  at 
all  affected.  From  a patient  of  Dr.  Daniel  T.  Coit;  an  exces- 
sively corpulent  woman,  sixty-two  years  of  age,  who  had  been 
complaining  only  for  nine  or  ten  weeks;  ascites  and  great 
irritability  of  the  stomach  were  the  principal  symptoms  ; bow- 
els constipated  ; very  little  if  any  pain  in  abdomen.  1833. 

This  form  of  carcinoma,  in  which  the  peritoneal  cavity  is 
found  to  be  filled  with  masses  of  disease,  the  organs  themselves 
being  healthy,  does  not  seem  to  be  very  generally  noticed, 
though  it  has  been  several  times  observed  here. 

hi.  Liver. 

545.  Cast,  in  plaster,  of  a fractured  liver;  a case  remarkable  for 
the  mildness  of  the  symptoms.  The  patient,  a little  girl, 
between  four  and  five  years  of  age,  was  run  over  by  a baker’s 
cart,  about  eight  o’clock  on  Monday  morning,  (Sept.  5th,  1837) ; 
through  that  forenoon  she  kept  upon  the  bed,  and  was  often 
faint,  but  felt  no  particular  uneasiness ; in  the  afternoon  she 
was  down  stairs,  and  on  the  floor  with  her  playthings  about  her. 
On  Tuesday,  she  was  out  upon  the  side-walk  in  front  of  the 


THE  ALIMENTARY  CANAL. 


163 


house.  On  Wednesday,  she  went  out  upon  the  Common, 
which  was  at  some  distance  from  where  she  lived,  and  there, 
as  her  mother  said,  she  played  about  and  rolled  upon  the  grass. 
Whilst  returning  home,  there  came  on  distress  at  the  stomach, 
which  continued  through  the  night,  and  was  at  times  quite 
urgent ; had  also  much  nausea  and  retching,  with  cold  perspi- 
ration. On  Thursday,  she  was  much  relieved,  and  the  symp- 
toms did  not  again  recur  with  the  same  severity.  From  this 
time,  however,  until  her  death  she  kept  on  the  bed,  though  she 
was  sometimes  able  to  enjoy  her  playthings ; had  frequent 
fainting  turns,  but  did  not  suffer  much.  Slept  well  through 
Thursday  and  Friday  nights,  but  seemed  on  the  whole  to  be 
rather  losing  strength,  and,  for  the  last  day  or  two,  there  was  a 
peculiarly  wild  expression,  as  if  from  severe  internal  injury. 
No  material  change  was  observed  on  Saturday  morning  until 
eleven,  A.  M.,  when  she  suddenly  fell  off  and  died  before 
twelve  o’clock. 

On  examination  after  death,  the  whole  surface  of  the  body  had 
an  icteritious  yellowness,  a symptom  which  existed  in  several 
other  cases  which  have  occurred  here,  and  may  be  regarded  as 
one  of  the  diagnostic  marks  of  the  accident.  The  abdomen 
was  tumid,  and  somewhat  bruised  over  the  lower  part,  but  not 
at  all  about  the  right  hypochondrium  ; neither  was  any  bruise 
found  about  the  region  of  the  liver  in  the  other  cases  just 
referred  to  ; this  fact  has  often  been  noticed  in  regard  to  the 
liver,  and  the  same  observation  might  be  extended  to  the  case 
of  injury  of  some  of  the  other  abdominal  organs  from  external 
violence.  The  cavity  of  the  peritoneum  contained  about  half 
a pint  of  blood,  mostly  liquid ; no  appearance  of  acute  inflam- 
mation. A large  mass,  equal  to  two  inches  and  a half  in 
diameter,  or  more,  was  broken  almost  off,  or  entirely  so,  from 
the  right  side  of  the  right  lobe  of  the  liver,  and  stood  out  very 
prominently  from  the  anterior  face  of  the  organ,  the  fractured 
portion  appearing  in  structure  like  any  other  part.  The  peri- 
toneum was  stripped  up  from  almost  the  whole  anterior  face  of 
the  right  lobe  of  the  liver,  and  beneath  it  was  a thick  layer  of 
coagulated  and  liquid  blood.  Blood  was  also  found  in  the 
pleural  cavity,  with  some  eccbymosis. 

546.  A section  of  the  liver,  to  show  the  structure  of  the  organ,  in 


164 


ORGANS  ACCESSORY  TO 


case  of  cirrhosis.  From  a man  who  died  at  the  Mass.  Gen. 
Hospital,  April  25th,  1838,  of  apoplexy ; he  was  very  corpu- 
lent, and  had  been  quite  intemperate  ; no  ascites. 

547.  Cirrhosis.  The  liver  is  so  reduced  in  size  that  the  whole 
organ  is  exhibited  in  a quart  jar.  Externally  it  is  granulated, 
and  very  irregular  in  its  general  outline.  Internally  the  gran- 
ules are  quite  distinct ; the  intervening,  hypertrophied,  and 
condensed  cellular  membrane  is  also  very  marked,  and  gave 
the  usual  indurated  feel.  When  recent,  the  color  was  yellow, 
mottled  with  red.  The  patient  was  a young  lady,  nineteen 
years  of  age,  and  had  been  under  the  care  of  Dr.  J.  Bigelow, 
who  gave  the  following  history  of  the  case  : — Was  subject  to 
headache,  and  had  several  times  had  erysipelas  of  the  face. 
In  July,  1839,  she  was  attacked  with  febrile  symptoms,  confin- 
ing her  for  a week,  and  was  afterwards  absent  from  the  city 
for  a month  or  two  with  indifferent  health.  In  September, 
Dr.  B.  found  her  complaining  of  pain  and  fulness  of  the  abdo- 
men, with  increased  pulse  and  heat,  diminished  appetite, 
costiveness,  scanty  urine,  and  disturbed  sleep.  On  examina- 
tion, a considerable  enlargement  of  the  abdomen  was  found, 
with  slight  fluctuation,  and  in  the  left  hvpochondrium,  a solid 
tumor,  moderately  sensible  to  pressure,  and  extending  two  or 
three  inches  below  the  cartilages  of  the  ribs.  The  ascites  after 
this  increased,  and  there  came  on  a general  cedema  of  the 
lower  extremities,  and  of  the  whole  trunk.  Occasionally  there 
were  attacks  of  head-ache,  pains  about  the  abdomen,  nausea 
with  vomiting,  and  a yellowness  of  the  skin  and  eyes,  but, 
when  relieved  from  these  symptoms,  she  pursued  her  usual 
occupation  for  several  days  at  a tune,  and  took  short  rides 
without  fatigue.  Twice  during  the  autumn  the  ascites  subsided, 
once  under  the  use  of  digitalis,  and  once  under  a spontaneous 
diarrhoea,  and  at  each  of  these  times  the  tumor  in  the  left  side 
could  be  felt.  In  April,  May,  June,  and  July  she  was  tapped, 
and  from  two  to  three  gallons  of  fluid  were  drawn  off  at  each 
time,  the  tumor  being  felt  as  before  after  each  operation. 
Towards  the  end  of  June  the  patient  rode  out  for  the  last  time, 
with  much  pain  and  fatigue.  The  anasarca  had  become  ex- 
cessive, and  dyspnoea  with  physical  signs  of  effusion  into  the 
right  pleural  cavity  supervened.  The  anasarca  after  this 


THE  ALIMENTARY  CANAL. 


165 


gradually  subsided,  and  rendered  apparent  an  excessive  emaci- 
ation ; the  countenance  became  haggard,  and  the  skin  exces- 
sively yellow ; pain  in  the  abdomen,  distress,  nausea,  and  dys- 
pnoea appeared  and  disappeared  on  various  days.  She  sat  up 
and  occupied  herself  with  sewing  for  the  greater  part  of  a day, 
about  a fortnight  before  her  death,  which  took  place  suddenly, 
on  the  29th  of  July,  after  the  vomiting  of  a pint  or  more  of  a 
blackish  fluid. 

On  dissection,  besides  the  disease  of  the  liver,  the  spleen 
was  found  much  enlarged,  and  formed  the  tumor  which  was 
felt  during  life.  The  peritoneal  cavity  contained  about  two 
gallons  of  serum,  with  a soft  false  membrane  over  the  intes- 
tines; there  was  also  an  effusion  of  serum  in  each  pleural 
cavity,  and  into  the  lower  portion  of  both  lungs.  The  stomach 
contained  nearly  a quart  of  dark,  brownish  fluid,  and  through- 
out the  small  intestine  was  found  a dark,  viscid,  tar-like  fluid. 
There  were  some  traces  of  effused  blood  about  the  organs,  but 
otherwise  they  were  healthy. 

548.  Old  tuberculous  disease  in  the  liver ; an  opaque,  white,  curdy 
mass,  about  the  size  of  an  English  walnut,  and  surrounded  by 
a firm  cyst.  Organ  otherwise  healthy.  From  a patient  of 
Dr.  Z.  B.  Adams ; a young  lady,  fourteen  years  of  age,  who 
died  of  acute  disease,  her  previous  health  having  been  quite 
good.  1840. 

549.  Abscess  of  the  liver.  A portion  of  the  organ  is  preserved, 
showing  a cavity  which  would  contain  a gill  or  more,  well 
defined,  though  rough  on  the  inner  surface,  and,  when  recent, 
containing  pus  and  mucus,  apparently  tinged  with  bile.  This 
cavity  was  near  the  under  surface  of  the  right  lobe,  and  com- 
municated with  the  duodenum,  and  there  were  also  in  the 
substance  of  the  organ  two  other  small  cavities  which  were 
filled  with  pure  pus.  The  liver  itself  was  small,  dark,  and 
universally  adherent.  The  patient,  a Scotchman,  fifty-seven 
years  of  age,  had  been  on  the  Western  coast  of  Africa  for  the 
last  twenty  years,  engaged  in  the  slave  trade,  his  general 
health  being  good,  though  he  had  had  the  fevers  of  that  region. 
In  May,  1843,  after  great  exposure,  he  was  attacked  with  dys- 
entery, which  was  very  severe  for  a time,  and  continued  more 


166 


ORGANS  ACCESSORY  TO 


or  less  until  his  death.  In  September,  he  arrived  here,  entered 
the  Mass.  Gen.  Hospital  in  a state  of  extreme  marasmus,  and 
died  in  about  ten  days  ; surface  very  pale,  but  not  at  all  yellow ; 
lower  extremities  cedematous.  Extensive  ulceration  was  found 
throughout  the  large  intestine,  but  in  a state  of  cicatrization. 
There  were  also  in  the  duodenum,  within  an  inch  of  the  pylo- 
rus, two  ulcers,  each  half  an  inch  in  diameter,  and  one  of  these 
communicated  with  the  abscess  in  the  liver. 

550.  A deep  fissure,  or  notch  in  the  edge  of  the  right  lobe  of  the 
liver,  as  if  there  had  been  a destruction  of  a portion  of  the 
organ  at  some  former  period.  From  a patient  of  Dr.  A.  A. 
Gould  ; a female,  about  forty-five  years  of  age,  who  died  from 
extensive  cancer  of  the  breast  and  liver,  this  disease,  however, 
having  no  connection  with  the  fissure.  1838. 

551.  A dried  specimen,  showing  the  spiral  valve  of  the  cystic  duct. 

552.  Congenital  deficiency  of  the  gall-bladder;  from  an  adult 
subject.  On  the  most  careful  examination  there  was  no 
appearance  of  the  organ  having  ever  existed ; such  cases  have 
been  met  with  here,  as  well  as  elsewhere,  in  the  foetus  and 
very  young  subjects,  but  its  occurrence  in  the  adult  must  be 
very  rare.  The  duct  was  of  the  usual  size,  and  showed  no 
remains  of  the  cystic  on  being  cut  open.  In  the  preparation, 
the  duct  is  seen,  with  a portion  of  the  liver,  duodenum,  and 
pancreas,  there  being  nothing  unusual  in  the  case,  excepting 
the  absence  of  the  gall-bladder.  From  a man,  twenty-six 
years  of  age,  who  entered  the  Mass.  Gen.  Hospital,  March 
20th,  1841,  and  died  on  the  same  day.  He  had  been  for  some 
months  in  a warm  climate,  and  had  had  severe  chronic  diar- 
rhoea, under  which  he  became  much  reduced;  pneumonia, 
however,  was  the  immediate  cause  of  his  death.  The  intes- 
tines were  generally  healthy. 

553.  Atrophy  of  the  gall  bladder,  from  an  obliteration  of  the  cystic 
duct ; the  hepatic  duct  is  seen  to  be  of  full  size,  and  a small 
pit  shows  the  remains  of  the  cystic.  From  a patient  of  Dr. 
Abner  B.  Wheeler ; a very  fleshy  woman,  about  eight}'  years 
of  age,  who  had  been  subject  for  three  or  four  years  to  attacks 


THE  ALIMENTARY  CANAL. 


167 


of  bilious  vomiting  and  diarrhcea,  lasting  for  some  days,  but 
not  confining  her  to  the  house ; was  quite  costive  during  the 
intervals.  The  attacks  became  more  frequent,  and  she  lost 
much  flesh,  but  seemed  to  die  at  last  rather  from  a general 
breaking  up  of  the  system  than  from  the  disease.  According 
to  Cruveilhier,  (Anat.  Path.  Liv.  xxix.)  the  circulation  of  the 
bile  and  the  digestion  go  on  perfectly  well  in  these  cases. 

554.  Gall-bladder  much  enlarged,  and  containing  a few  calculi ; 
inflated  and  dried. 

555.  Gall-bladder  ossified ; contained  numerous  calculi,  about  the 

size  of  a pea.  Dr.  Robert  Thaxter , of  Dorchester. 

556.  Dilatation  of  the  bile-ducts.  From  a patient  of  Dr.  John 
Jeffries;  an  old  lady,  eighty  years  of  age,  who  had  been  sub- 
ject to  biliary  attacks  for  sixteen  years  before  her  death. 
These  attacks  came  on  with  vomiting,  which  was  followed  by 
pain  in  the  right  hypochondrium,  which  extended  to  the  back, 
with  extreme  tenderness  over  the  region  of  the  gall-bladder ; 
occasionally  she  had  large,  black  discharges  of  viscid  bile, 
which  gradually  became  thinner  as  she  got  relief.  During  one 
of  these  attacks,  three  weeks  before  her  death,  the  liver  was 
found  to  be  enormously  enlarged,  but  returned  to  its  usual  size 
as  the  attack  passed  off.  On  dissection,  a calculus,  of  the  size 
of  a pigeon’s  egg,  was  found  in  the  duct  just  above  the  opening 
into  the  intestine,  and,  upon  the  inner  surface  of  the  duct  was 
an  old,  greyish  ulcer,  corresponding  in  situation  to  the  calculus. 
The  duct  measured,  at  this  part,  two  inches  and  three-fourths 
transversely,  when  cut  open,  and  throughout  the  liver  the  dila- 
tation was  in  proportion.  In  the  gall-bladder  were  numerous 
calculi,  and  upon  its  inner  surface  was  an  old  ulcer,  similar  to 
that  in  the  duct,  and  which  had  penetrated  through  to  the  liver. 
The  ducts  are  preserved,  with  the  gall-bladder,  and  a portion 
of  the  intestine  ; the  calculus  was  very  little  more  than  a mere 
shell,  and  was  soon  broken.  1842. 

557.  Dilatation  of  the  bile  ducts.  In  the  preparation,  the  hepatic 
duct,  with  its  branches  throughout  the  liver,  and  also  the  gall- 
bladder, were  injected  with  wax,  &c., colored  yellow;  the  liver 


168 


ORGANS  ACCESSORY  TO 


having  then  been  dissected  away,  and  with  it  the  smaller 
injected  ducts,  the  hepatic  duct,  with  the  larger  branches,  and 
the  gall-bladder,  were  dried,  and  mounted  upon  a pedestal. 
The  circumference  of  the  hepatic  duct  is  now  four  and  a half 
inches,  and  its  branches  are  of  proportionate  size,  the  dilatation 
being  regular;  cystic  duct  two  and  a half  inches;  the  gall- 
bladder, which  was  not  quite  filled,  is  five  inches  in  length,  and 
nearly  ten  inches  in  circumference  at  the  largest  part. 

In  the  recent  dissection,  the  source  of  disease  appeared  to 
be  in  the  pancreas,  a mass  of  dark,  grumous,  coagulated 
blood,  about  the  size  of  an  English  walnut,  being  found  in  the 
substance  of  this  organ,  about  an  inch  from  its  right  extremity ; 
the  cavity,  in  which  this  was  contained,  was  rough  upon  the 
inner  surface,  but  sufficiently  well  defined,  and  without  any 
distinct  appearance  of  malignant  disease.  At  this  part  the 
hepatic  duct  appeared,  just  at  its  termination,  to  be  lost  in  the 
pancreas ; the  ductus  communis,  which  was  almost  imbedded 
in  the  organ,  communicated  directly  with  the  cavity  in  the 
pancreas,  and  was  filled  with  grumous  blood,  which  could 
easily  be  pressed  through  into  the  intestine,  the  duct  being 
about  one  inch  and  a half  in  length,  and  from  ten  to  twelve 
lines  across  when  cut  open. 

The  pancreas  was  of  about  the  usual  size,  except  perhaps 
for  some  enlargement  towards  the  right  extremity,  but  the  duct 
was  much  dilated,  the  opening  into  the  intestine  being  obliter- 
ated. Between  the  seat  of  disease  and  the  left  extremity  the 
duct  measured,  when  cut  open,  from  one  to  one  and  a half 
inches  across,  the  inner  surface  being  very  irregular,  as  it 
usually  is  when  dilated  ; about  the  head  of  the  organ  the  dila- 
tation was  less,  but  still  enough  to  be  seen  externally,  and  to 
give  the  appearance,  when  the  parts  were  in  situ,  of  an  encysted 
disease.  The  fluid,  with  which  it  was  distended,  was  perhaps 
rather  thinner  than  the  common  pancreatic  secretion,  but  quite 
colorless,  except  for  a little  blood  near  the  seat  of  disease,  and 
which  probably  got  in  in  the  course  of  the  dissection.  A fluid, 
having  precisely  the  same  appearance,  filled  the  hepatic  ducts 
and  the  gall-bladder,  so  as  to  run  freely  when  a small  portion 
of  the  liver  was  accidentally  cut  off,  no  trace  of  bile  being 
found  in  them.  The  gall-bladder  alone  contained,  as  a sedi- 
ment, a small  quantity  of  grumous  blood,  which  had  probably 


t 


THE  ALIMENTARY  CANAL. 


169 


got  in  from  the  cavity  in  the  pancreas  at  some  former  time, 
the  fluid  being  otherwise  quite  as  clear  as  it  was  in  the  ducts. 
To  explain  the  above  appearances,  there  was  found  an  opening, 
sufficient  to  admit  a large  probe,  between  the  pancreatic  and 
hepatic  ducts,  and  at  the  point  where  the  hepatic  was  lost  in  the 
substance  of  the  pancreas. 

The  liver  was  of  moderate  size,  quite  dark,  and  flaccid. 
The  stomach  and  intestines  were  opened  throughout,  but  no- 
thing unusual  was  observed,  except  an  entire  absence  of  bile, 
and  in  the  upper  part  of  the  small  intestine  a considerable 
quantity  of  grumous  blood. 

The  patient  was  a music-master,  about  sixty-five  years 
of  age,  and  very  intemperate.  Nothing  is  known  of  his 
history,  previous  to  August,  1843,  when  he  was  turned  off 
from  his  boarding-house,  because  he  was  disagreeable  from  his 
extreme  yellowness.  From  that  time  until  his  death,  in  the 
following  January,  the  jaundice  was  complete ; appetite  inordi- 
nately strong ; pain  in  the  epigastrium,  with  some  nausea,  and 
towards  the  last,  hiccough ; discharges  from  the  bowels  very 
offensive,  and  sometimes  there  was  diarrhoea.  He  became 
much  emaciated,  but  kept  about  until  a short  time  before  his 
death,  not  being  confined  to  the  bed,  and  scarcely  even  to  the 
house. 

558.  Gall-bladder,  not  enlarged,  but  perfectly  filled  with  calculi,  as 
in  a specimen  figured  by  Dr.  Baillie. 

Dr.  Charles  G.  Putnam. 

559.  A second  specimen,  similar  to  the  last.  Dr.  John  Dixweil. 

560.  A portion  of  the  gall  bladder,  showing  a firm  adhesion  of 
several  calculi  to  its  inner  surface;  a dry  preparation,  the 
adhesion,  in  the  recent  state,  being  quite  firm. 

561.  A dried  specimen,  showing  dilatation  of  the  hepatic  and  com- 
mon ducts.  This  last  is  obstructed  near  its  opening  into  the 
intestine  by  a calculus  about  as  large  as  the  end  of  the  little 
finger,  and  this  was  the  cause  of  death.  In  the  hepatic  duct, 
near  the  cystic,  is  a smaller  calculus,  which  is  not  fixed.  The 
gall-bladder  was  much  diseased  on  the  inner  surface,  and  con- 

22 


170 


ORGANS  ACCESSORY  TO 


traded  about  several  white  calculi,  which  contrast  strongly 
with  those  in  the  duct,  the  cystic  duct  being  probably  obliter- 
ated. From  a patient  of  Dr.  Samuel  Parkman;  a female, 
thirty-nine  years  of  age ; was  taken  with  violent  pain  in  the 
right  hypochondrium,  and  on  the  fourth  day  of  the  attack, 
when  first  seen  by  Dr.  P.,  the  pain  continued  with  great  vio- 
lence, and  wras  accompanied  with  prostration,  the  pulse  being 
feeble,  and  the  extremities  cold ; bowels  constipated.  The 
pain  was  relieved  by  laudanum,  but  on  the  following  morning 
it  returned,  and  was  again  relieved.  On  the  sixth  day  it  was 
found  that  she  had  died  in  one  of  the  paroxysms,  having 
become  very  much  jaundiced  the  day  before.  Patient  had 
been  subject  to  similar  attacks  in  former  years.  1840. 

562.  A calculus,  of  a regular  ovoid  form,  and  about  the  size  of  the 
last  joint  of  the  thumb;  taken  from  one  of  the  ducts.  1845. 

Dr.  Winslow  Lewis. 

563.  A calculus,  three  or  four  lines  in  diameter.  “Taken  with 
four  others  from  an  abscess  in  the  liver.”  The  patient  was  a 
female,  thirty-eight  years  of  age.  1839. 

Dr.  Miller , of  Pawtucket. 

564.  Several  hundred,  small  white  calculi,  found  interspersed 
throughout  an  immense  mass  of  encephaloid  disease,  which 
had  formed  in  or  upon  the  right  lobe  of  the  liver.  The  disease 
was  thought  to  have  originated  in  the  gall-bladder ; a small 
portion  only  of  this  organ  remained,  in  the  parietes  of  which 
was  a decidedly  malignant  deposit,  and  into  the  cavity  of  which 
there  protruded  a fungous  mass ; the  cavity,  also,  such  as  it 
was,  contained  several  calculi.  By  washing  and  breaking  up 
the  diseased  mass,  six  hundred  and  thirty-eight  calculi  were 
removed,  and  two  or  three  hundred  more  could  undoubtedly 
have  been  obtained,  if  time  and  patience  had  allowed.  The 
liver  itself  was  healthy,  except  for  a malignant  deposit  in  the 
left  lobe.  From  a patient  of  Dr.  John  Flint;  a very  large, 
fleshy  woman,  fifty-four  years  of  age,  who  had  been  subject  to 
attacks  of  pain  in  the  right  hypochondrium,  with  vomiting  of 
bile  and  yellowness  of  the  skin,  lasting  generally  eight  or  ten 
days ; for  the  last  four  months  a very  large  tumor  had  been 
felt  below  the  right  hypochondrium.  1835. 


THE  ALIMENTARY  CANAL. 


171 


565.  A calculus  discharged  per  anum.  It  is  of  a very  regular  and 
somewhat  oval  form,  and  measures  three  inches  and  three- 
fourths  in  its  greatest  circumference,  and  three  inches  in  its 
least.  The  interior,  which  is  perfectly  white,  seems  to  consist 
of  pure  cholesterine,  and  this  is  surrounded  by  a brown  crust 
about  two  lines  in  thickness,  the  calculus  having  been  sawed 
open.  The  patient,  a female,  seventy-live  years  of  age,  had 
had  repeated  attacks  of  vomiting,  with  constipation,  and  pain 
in  the  epigastrium.  After  an  unusually  severe  attack  in 
September  she  passed  the  calculus,  and  from  that  time 
remained  tolerably  comfortable  until  the  middle  of  November, 
when  there  came  on  the  symptoms  of  organic  disease,  and  she 
died  on  the  13th  of  December.  On  dissection,  a scirrhous 
mass  was  found  in  the  region  of  the  gall-bladder,  involving  the 
pylorus,  duodenum,  and  a portion  of  the  colon,  into  which  last 
the  calculus  had  passed,  and  through  a direct  communication, 
a small,  puckered  cavity,  about  the  size  of  an  olive,  being  all 
that  remained  of  the  gall-bladder.  The  case  was  published  in 
the  New-England  Journ.  of  Med.  and  Surg.  for  January,  1826, 
and  in  the  No.  for  January,  1825,  there  is  reported  another 
case,  which  also  occurred  in  this  neighborhood,  and  in  which  a 
calculus,  nearly  two  inches  in  length,  passed  directly  from  the 
gall-bladder  into  the  duodenum. 

Dr.  Abel  L.  Peirson , of  Salem. 

566.  A calculus  discharged  from  the  umbilicus ; equal  to  about  an 
inch  in  diameter,  and  much  worn  at  one  extremity.  This  was 
received  from  the  patient  herself,  a female,  fifty-five  years  of 
age,  with  the  following  history:  — For  six  or  seven  years  there 
had  been  symptoms  of  the  disease ; she  then  became  more 
sick,  and  having  been  confined  to  her  room  for  thirteen  months, 
an  opening  took  place  at  the  umbilicus  in  February,  1836, 
and  had  continued  from  that  time,  discharging  for  the  first  six 
months  a watery  fluid,  afterwards  pus  in  large  quantities,  with 
an  occasional  mixture  of  bile,  and  latterly,  a mucous  fluid. 
The  calculus  was  discharged  in  April,  1837,  having  been  felt 
for  some  weeks  previously.  About  three  weeks  afterwards  a 
second  began  to  be  felt,  and  in  June  she  entered  the  Mass. 
Gen.  Hospital  to  have  it  removed.  Patient  has  never  had 
jaundice,  and  thinks  her  general  health  much  improved  since 
the  opening  took  place.  June,  1837.  Dr.  J.  B.  S.  Jackson. 


172 


ORGANS  ACCESSORY  TO 


567.  A collection  of  987  calculi,  about  enough  having  been  lost  to 
make  up  the  thousand ; vary,  in  size,  from  one  to  four  lines, 
and  have  marked  fapettes.  From  a man,  thirty-eight  years  of 
age,  who  had  been  insane  for  two  years,  but  had  no  disease  of 
the  liver,  and  no  indication  during  life  of  a disorder  of  that 
organ,  so  far  as  was  known.  August  28th,  1845. 

Dr.  J.  B.  S.  Jackson. 

568.  A very  regular,  smooth,  dark  brown,  ovoid  calculus,  nearly 
the  size  of  a pullet’s  egg.  From  a woman,  fifty-eight  years 
of  age,  who  died  of  disease  of  the  chest.  January  13th,  1845. 

Dr.  J.  B.  S.  Jackson. 

569.  A calculus,  about  the  size  of  a small  nutmeg,  and  resembling 
one  in  structure,  having  been  sawed  open. 

570.  A single  calculus,  of  a regular,  oval  form,  and  about  the  size 
of  a small  nutmeg.  It  has  the  consistence  of  cholesterine,  but 
differs  from  it  in  being  translucent  rather  than  opaque  ; not 
sawed  open,  but  appears  on  the  surface  light  colored,  rough, 
glistening,  crystalized,  and  resembling  somewhat  the  mineral 
phrenite.  From  a female,  twenty-four  years  of  age,  who  died 
of  phthisis  at  the  Mass.  Gen.  Hospital.  June  24th,  1838. 

571.  The  fragments  of  a large  hollow  calculus,  which  was  found  in 

a case  of  dilatation  of  the  bile  ducts  (No.  556) ; the  outer 
shell  is  quite  compact,  but  not  more,  generally,  than  half  a line 
in  thickness.  1842.  Dr.  John  Jeffries. 

572.  Forty-seven  different  collections  of  biliary  calculi,  showing  the 
difference,  in  regard  to  numbers,  and  in  their  physical  appear- 
ance, externally  and  internally,  as  observed  in  different  sub- 
jects. The  histoiy  of  many  of  the  cases  is  recorded  in  the 
Manuscript  Catalogue  of  the  Cabinet. 

iv.  Panckeas. 

573.  Scirrhus  of  the  pancreas.  The  diseased  mass  is  in  the  right 
extremity  of  the  organ,  two  inches  in  diameter,  or  more,  quite 
defined,  and  extremely  dense.  When  recent,  the  cut  surface 


THE  ALIMENTARY  CANAL. 


173 


appeared  white,  smooth,  shining,  and  nearly  uniform,  showing 
no  traces  of  the  glandular  structure.  The  duct,  however, 
passed  directly  through  it,  and,  being  somewhat  contracted  at 
this  part,  it  is  marked  in  the  preparation  by  a thread.  Other- 
wise, the  organ  is  healthy,  and  the  duct  enlarged.  The  liver 
contained  numerous  scirrhous  masses,  with  similar  disease  in 
the  adjacent  lymphatic  glands  and  also  in  the  lungs.  From  a 
patient  of  Dr.  D.  H.  Storer ; a man  fifty-two  years  of  age,  a 
painter  by  trade,  had  always  an  unhealthy  look,  but  considered 
himself  as  well  until  about  six  months  before  death,  when  he 
began  to  lose  his  appetite,  and  complain  of  pain  in  the  epigas- 
trium and  left  hypochondrium.  Continued  to  work  for  two  or 
three  months  ; then  gave  up,  and  was  afterwards  for  most  of 
the  time  confined  to  his  bed.  Dr.  S.  then  first  discovered  an 
induration  in  the  epigastrium,  with  tenderness  on,  pressure. 
Became  greatly  emaciated,  but  throughout  his  disease  there 
was  neither  nausea  nor  vomiting,  precluding  the  idea  of  a 
scirrhous  affection  of  the  stomach,  which  would  otherwise  have 
been  suspected  ; bowels  rather  confined.  1838. 

574.  Encephaloid  disease  of  the  left  extremity  of  the  pancreas ; the 
organ  is  cut  open,  and  is  seen  to  be  otherwise  healthy.  From 
a patient  of  Dr.  H.  B.  Inches ; an  unmarried  woman,  fifty-five 
years  of  age,  who  had  suffered  for  many  years  from  emphy- 
sema of  the  lungs,  and  bronchitis,  but  was  otherwise  in  good 
health.  In  the  spring  of  1842,  she  began  to  fail,  and  died, 
gradually  exhausted,  on  the  25th  of  September.  Disease  of 
the  liver  was  recognized,  and,  on  dissection,  this  organ  was 
found  studded  with  encephaloid  masses.  A similar  deposit 
was  also  found  in  the  bronchial  and  mesenteric  glands,  and  in 
some  fibrous  tumors  which  happened  to  exist  in  the  uterus. 
There  had  been  much  thirst,  with  total  anorexia,  but  no  symp- 
tom which  referred  particularly  to  the  pancreas. 

575.  Several  pancreatic  calculi;  they  are  situated  near  the  right 
extremity  of  the  organ,  and  two  of  them  are  about  the  size  of 
a pea.  They  are  shown  in  situ  in  the  gland,  the  duct  of  which 
is  enlarged  throughout,  so  as  to  measure  at  one  part  one  inch 
across,  when  cut  open.  From  a man,  thirty-five  years  of  age ; 
his  habits  were  very  intemperate,  and  he  died,  at  the  Alms- 


174 


ORGANS  ACCESSORY  TO 


house,  from  the  rupture  of  a blood-vessel  in  the  parietes  of  the 
stomach,  the  mucous  membrane  appearing  quite  healthy  in  the 
immediate  neighborhood;  had  had  vomiting  and  purging  of 
blood  for  about  a week ; as  such  a rupture  must  be  quite  rare, 
it  may  be  mentioned  that  a similar  case  occurred  here  a few 
years  since. 

576.  Extensive  disease  of  the  pancreas,  the  case  being  interesting 
from  the  circumstance  of  there  having  been  for  a time  fatty 
discharges  from  the  bowels.  The  patient  was  a laboring  man, 
forty  years  of  age.  Thirteen  years  before  death  he  was 
greatly  reduced  by  haemorrhage  from  the  bowels,  and  to  this 
he  always  referred  as  the  origin  of  his  disease ; three  years 
before  death  he  had  a second  attack,  which  was  quite  severe, 
and  lasted  for  several  weeks.  There  was  great  tenderness  in 
the  epigastrium,  with  frequent  returns  of  diarrhoea  and  dis- 
charges of  blood,  the  functions  of  the  stomach,  meanwhile, 
being  sufficiently  well  performed. 

In  December,  1836,  after  working  all  the  day  in  a damp 
cellar,  he  was  attacked  with  febrile  symptoms,  pain,  and  obsti- 
nate constipation,  which  last,  after  a few  days,  was  followed  by 
severe  diarrhoea;  the  discharges  contained  no  bile,  but  con- 
sisted in  a great  measure  of  blood,  and  the  tenderness  in  the 
epigastrium  was  extreme.  In  about  a fortnight  a fatty  sub- 
stance was  first  noticed,  and  from  this  time  it  was  observed, 
more  or  less,  in  every  discharge  from  the  bowels  until  the 
month  of  May,  when  it  entirely  ceased.  During  this  attack 
the  patient  was  attended  by  Dr.  A.  A.  Gould,  who  made  a full 
report  of  the  case,  at  the  time,  to  the  Society,  and  from  which 
the  following  is  an  extract: — “There  were  about  ten  dejec- 
tions daily,  and  they  contained  a transparent,  oily  substance, 
which,  in  about  five  minutes,  formed  a hard  coating  upon  the 
surface.  When  examining  the  night  vessel  in  the  morning, 
after  five  or  six  dejections,  there  would  be  found  a coating,  an 
inch  in  thickness,  of  the  consistence  and  appearance  of  beef 
tallow.  Patient  declares  that  for  six  weeks  he  must  have  dis- 
charged, on  an  average,  half  a pound  of  this  substance  daily ; 
is  also  positive  that  he  had  no  discharges  of  fat  except  after 
eating  meat  or  food  cooked  in  fatty  matters,  that  they  would 
cease  in  twenty-four  hours  after  abstaining  from  meat,  and 


THE  ALIMENTATtY  CANAL. 


175 


return  again  after  resuming  it ; his  wife,  however,  is  confident 
that  there  was  no  such  connection.  Nothing  of  the  kind  was 
ever  observed  in  the  urine.” 

After  the  febrile  symptoms  disappeared  he  was  able  again 
to  go  to  work.  The  pain  and  tenderness,  however,  continued, 
and  he  had  frequent  paroxysms  of  severe  distress,  which  could 
only  be  relieved  by  large  doses  of  laudanum,  these  attacks 
coming  on  every  eight  or  ten  days,  but  becoming  more  frequent 
as  the  disease  advanced.  For  the  first  five  months  the  appe- 
tite was  good  and  often  craving,  but  afterwards  became  indiffe- 
rent. The  discharges  from  the  stomach  and  bowels,  however 
produced,  were  uniformly  and  entirely  deficient  in  bile  after 
the  attack  in  December,  and  for  the  last  five  weeks  there  was 
complete  jaundice.  About  the  last  of  August,  Dr.  Woodbridge 
Strong  took  charge  of  the  case,  and  found  the  symptoms  above 
described ; the  abdomen  was  extremely  tender,  and  there  was 
found  a tumor  in  the  epigastric  and  right  hypochondriac 
regions,  which  extended  nearly  to  the  umbilicus ; there  were 
also  the  signs  of  advanced  phthisis.  The  patient  sat  up  evei’y 
day  until  a short  time  before  his  death,  and,  when  in  bed,  laid 
always  upon  the  right  side,  with  the  body  bent  forward.  On 
the  16th  of  September  he  was  found  partially  comatose,  and 
on  the  following  day  he  died. 

On  opening  the  cavity  of  the  abdomen,  a large  fluctuating 
tumor,  of  a regular  oval  form,  was  at  once  seen  below  the 
right  lobe  of  the  liver,  with  which  it  was  closely  connected  by 
old  adhesions : it  was  situated  between  the  intestine  and  the 
posterior  parietes  of  the  abdomen,  and  extended  towards  the 
left  side  somewhat  beyond  the  spine  ; the  duodenum  ran  over, 
and  almost  around  it.  On  making  a free  incision  into  the 
tumor,  it  was  found  to  contain,  by  estimate,  from  ten  to  four- 
teen ounces  of  a bloody-looking,  serous  fluid,  without  coagula, 
not  viscid  nor  greenish,  and  without  any  appearance  of  fatty 
matter.  The  tumor  or  cyst,  after  removal  from  the  body, 
measured  four  inches  by  three  in  extent,  its  walls  being  from 
one  to  three  lines  in  thickness,  of  a reddish  color,  membranous, 
and  fleshy  to  the  feel.  Nothing  could  be  discovered  like  the 
structure  of  the  pancreas ; yet  the  parietes  of  the  cyst  were 
evidently  formed  by  a dilatation  of  that  organ,  as  they  con- 
tained several  very  minute  calculi.  The  inner  surface  was  for 


176 


ORGANS  ACCESSORY  TO 


the  most  part  firm  and  smooth,  but  on  the  side  towards  the 
duodenum,  it  was,  to  a small  extent,  irregular,  soft,  and  appa- 
rently disorganized  : two  calculi  adhered  to  it  near  the  opening 
of  the  duct,  which  was  entirely  obliterated : they  were  three 
or  four  lines  in  diameter,  rough  on  the  surface,  had  the  usual 
characters  of  pancreatic  concretions,  and,  one  of  them,  on 
being  analyzed  by  Dr.  Charles  T.  Jackson,  was  found  to  con- 
sist of  the  carbonate  of  lime  ; there  was  a third,  also,  but  much 
smaller.  The  remainder  of  the  pancreas,  forming  the  left 
extremity  of  the  organ,  was  about  two  inches  in  length,  much 
contracted,  and  feeling  veiy  hard,  as  if  filled  with  small  cal- 
culi ; the  duct  itself  was  considerably  enlarged,  and  opened 
freely  into  the  cavity  of  the  sac.  There  was  no  appearance  of 
malignant  disease  about  the  tumor,  nor,  indeed,  in  any  part  of 
the  body.  The  stomach  was  small,  and  pushed  high  up  in  the 
abdomen ; contained  some  thin  liquid  of  a light  but  decidedly 
yellowish  color ; about  seven  feet  of  the  ileum  were  opened, 
but  there  was  no  trace  of  bile.  The  liver  was  small,  dark- 
colored,  and  thrust  high  up  by  the  tumor.  The  gall-bladder 
was  large  and  distended  with  moderately  thick  bile*,  of  a dark 
green  color.  The  ducts  were  dilated  and  full  of  bile,  but 
without  any  particular  obstruction.  The  common  duct  was 
traced  freely  into  the  duodenum : on  slitting  it  open,  a portion 
of  it,  which  formed  a part  of  the  parietes  of  the  cyst,  was 
found  in  a very  sloughy  condition,  and  similar  to  the  appear- 
ance already  described  upon  the  inner  surface  of  the  sac,  with 
which  it  corresponded,  it  being  evident  that  an  opening  was 
about  to  be  formed,  if  it  did  not  already  exist,  between  the  sac 
and  the  hepatic  duct. 

This  case  has  already  been  published  by  Dr.  Gross,  in  his 
work  on  Pathological  Anatomy. 

v.  Spleen. 

577.  A portion  of  the  spleen,  from  which  the  blood  has  been 
washed,  to  show  the  parenchyma. 

578.  Cast  in  plaster  of  a fractured  spleen.  From  a Hospital 
patient ; a man  thirty-two  years  of  age,  fell  twenty  feet,  and 
struck  upon  his  left  side.  Seen  a quarter  of  an  hour  after- 


THE  ALIMENTARY  CANAL. 


177 


wards,  and  was  then  in  a perfect  state  of  collapse ; great  pain 
in  abdomen,  particularly  in  the  left  lumbar  region,  which  was 
extremely  tender,  though  without  any  external  injury.  Soon 
after  getting  into  bed,  he  passed  about  §x.  of  nearly  clear 
blood  from  the  bladder.  Pain  continued,  with  great  restless- 
ness and  ineffectual  attempts  to  vomit,  and  he  died  in  an  hour 
and  a half  after  the  accident.  On  dissection,  there  was  found 
in  the  peritoneal  cavity  §xl.  or  more  of  dark  fluid  blood,  with 
an  extensive  and  comminuted  fracture  of  the  spleen  and  left 
kidney,  and  a slight  fracture  of  the  left  lobe  of  the  liver ; sev- 
eral ounces  of  blood  about  kidney,  with  ecchymosis  on  left  of 
spine  as  far  down  as  the  pelvis.  No  other  internal  injury,  but 
externally  there  was  found  dislocation  with  fracture  of  the  left 
humerus.  February  2d,  1838.  Dr.  Henry  J.  Bigelow. 

579.  Ossific  plate,  about  an  inch  in  diameter,  from  the  surface  of 
the  spleen;  a dried  specimen.  The  organ  was  much  enlarged, 
and  weighed  a pound,  when  recent.  From  a man,  fifty-eight 
years  of  age,  who  died  from  a great  variety  of  internal  disease. 

580.  A second  specimen,  similar  to  the  last,  but  rather  larger. 
1844. 

581.  Spleen  very  much  enlarged,  and  about  three-fourths  of  its 
substance  filled  with  softening,  tuberculous  matter.  Extensive 
disease  was  found  in  the  lungs,  bronchial  and  lymphatic 
glands,  and  in  the  intestines ; also  a few  tubercles  in  the  liver, 
kidneys,  bladder,  uterus,  and  heart.  From  a patient  of  Dr. 
Martin  Gay ; eight  and  a half  months  old,  and  belonging  to  a 
highly  tuberculous  family,  but  was  healthy  until  three  months 
before  death,  when  it  had  hooping-cough,  and  from  that  time 
a general  decline.  The  spleen  was  felt  very  distinctly,  as  a 
large  and  movable  tumor,  for  two  weeks  before  death,  extend- 
ing nearly  to  the  crest  of  the  ilium. 

A similar  enlargement  has  been  felt  during  life  in  some 
other  cases  of  general  tuberculous  disease,  in  young  sub- 
jects, which  have  occurred  here,  and,  in  one  of  them, 
where  there  was  an  absence  of  any  very  marked  local 
symptoms,  this  sign  led  to  a correct  knowledge  of  the  nature 
of  the  case. 

23 


178 


ORGANS  ACCESSORY  TO  ' 


582.  Extensive,  tuberculous  disease  of  the  spleen,  but  very  much 
less  than  in  the  last  case ; the  lungs,  bronchial  glands,  and 
liver  were  also  diseased.  From  a patient  of  Dr.  Charles  E. 
Ware ; an  infant,  twenty-five  months  old,  who  began  to  fail  from 
the  age  of  six  months,  when  it  was  weaned.  1838. 

583.  A peculiar  disease  of  the  spleen,  found  in  connection  with 
disease  of  the  heart,  and  owing  perhaps  to  a former  inflamma- 
tion of  the  cells  of  the  organ. 

As  I believe  this  to  be  rather  an  unusual  affection,  I would 
give  here  the  result  of  observations  upon  eleven  cases  in  which 
I have  happened  to  meet  with  it.  The  disease  consisted  of 
one  or  more  perfectly  defined,  opaque,  yellowish,  firm  masses 
in  the  substance  of  the  organ,  extending  to  the  surface,  but 
never  projecting  above  it.  The  form  of  the  masses  was  irreg- 
ular, and  they  varied  in  size  generally  from  three  lines  to  an 
inch  or  more ; often  surrounded  by  a little  loose  cellular  tissue, 
but  never  encysted.  Except  in  one  case,  where  there  was  a 
cadaveric  red  stain,  the  color  of  the  mass  was  whitish  in  two, 
and  more  or  less  yellow  in  all  of  the  rest,  sometimes  faint, 
but  often  bright,  so  as  to  contrast  strongly  with  the  rest  of  the 
organ ; in  some  of  the  less  perfect  cases,  however,  there  was 
an  intermixture  of  red.  This  yellow  color,  except  for  its 
intensity  in  some  of  the  cases,  might  be  expected,  supposing 
the  disease  to  be  the  result  of  former  inflammation  of  the  cells 
of  the  organ  ; a similar  discoloration  of  the  fibrinous  clot  being 
not  unfrequently  observed  in  old  cases  of  phlebitis.  The 
structure  was  veiy  nearly  uniform,  and  the  cut  surface  smooth ; 
but  with  a distinct  appearance,  as  of  blood-vessels,  in  some  of 
the  masses.  The  corresponding  surface  of  the  organ,  exter- 
nally, was  opaque,  the  color  showing  through  more  or  less 
from  beneath,  although  in  one  case  the  existence  of  the  disease 
was  only  indicated  externally  by  a deep  red  color ; the  whole 
surface  was  sometimes  depressed,  and  sometimes  not  at  all  so, 
but  more  frequently  there  was  a narrow  depression  about  the 
limits  of  the  disease ; old  peritoneal  adhesions  were  also  some- 
times found.  The  spleen  itself  was  generally  noted  as  of  the 
usual  size ; in  one  case  it  was  small,  in  two  it  was  large,  in  one 
it  was  three  or  four  times  its  usual  size,  and  in  one  it  was  found 
to  weigh  twenty-three  ounces  (avoir.) ; in  the  last  case  the 


•THE  ALIMENTARY  CANAL. 


179 


patient  had  had  intermittent  fever  four  years  before  death. 
There  was  never  any  appearance  of  tuberculous  disease,  nor 
of  softening  of  the  masses,  and  in  one  case  only,  was  there 
anything  like  acute  inflammation,  the  substance  of  the  organ 
in  three  places  being  firm,  quite  friable,  and  comparatively  of  a 
dark  red  color ; in  five  cases  it  is  expressly  stated  that  there 
were  no  tubercles  in  the  lungs,  an  important  point  in  regard  to 
the  nature  of  the  disease  of  the  spleen.  In  one  case  a very 
marked,  dark  red,  ecchymosed  appearance  surrounded  the 
diseased  mass  to  the  extent  of  two  or  three  lines,  and  this  was 
the  only  indication  of  an  apoplectic  condition  that  was  ever 
observed. 

All  of  the  patients,  excepting  one,  were  adults.  Most  of 
them  died  of  complicated  organic  disease,  three  of  organic 
disease  of  the  brain,  one  of  phthisis,  and  one,  a lad  ten  years 
of  age,  of  cerebral  disease  after  scarlatina.  With  one  excep- 
tion only,  there  was  in  every  case  well-marked  organic  disease 
of  the  heart,  and  in  six  there  were  vegetations  upon  the  valves  ; 
in  one  case,  there  was  a fibrinous  mass,  infiltrated  with  puriform 
fluid,  dnd  as  large  as  the  top  of  the  thumb,  in  the  appendix  of 
the  right  auricle ; in  one  of  the  six  cases,  just  referred  to, 
besides  the  vegetations  upon  the  valves,  there  was  fibrine 
adhering  to  the  inner  surface  of  the  left  auricle,  and  apparently 
becoming  organized,  and  in  another  there  was  inflammation  of 
the  iliac  and  femoral  arteries,  these  vessels  being  filled  with 
lymph.  (No.  361.)  There  being,  then,  this  tendency  in  the 
vascular  system,  it  is  not  very  surprising,  considering  its  struc- 
ture, that  the  spleen  should  be  similarly  affected. 

Cases  of  this  disease  have  been  observed  by  Dr.  Hodgkin, 
Prof.  Rokitanski,  and  M.  Cruveilhier.  Prof.  R.  is  inclined  to  con- 
nect the  change  in  the  spleen  with  some  peculiar  state  of  the 
blood,  and  the  result  of  the  cases  above  analyzed  is  interesting 
in  connection  with  this  view  of  the  subject ; Prof.  R.  has  fur- 
ther observed  a chronic  affection  of  the  kidneys,  as  a frequent 
occurrence  in  his  cases,  and  on  a review  of  those  which  have 
been  above  reported,  it  appears  that  in  three  of  them  a similar 
change  was  found.  The  above  analysis  having  been  sent  to 
Dr.  Thomas  Hodgkin,  was  communicated  by  him  to  the  Med- 
ico-Chirurgical  Society,  and  published,  with  some  remarks  by 
Dr.  H.,in  the  Transactions  of  the  Society.  (Vol.  xxix.  p.277.) 


180 


URINARY  ORGANS. 


In  the  specimen  which  has  been  preserved  to  represent  this 
disease,  the  whole  mass,  when  recent,  was  of  a golden  yellow 
color,  though  it  has  now  become  quite  pale.  1839. 

584.  Atrophied  spleen ; it  is  very  diminutive  in  size,  has  a wilted 
appearance,  and  adhered  intimately  to  the  neighboring  organs. 
From  an  old  woman,  who  died  of  bronchitis ; a patient  of  Dr. 
John  Homans.  1844.  , 


IX.  URINARY  ORGANS. 


i.  Kidneys. 

585.  A horse-shoe  kidney ; from  an  adult  subject.  The  fusion 

seems  to  be  perfect,  and,  as  usual,  by  the  lower  extremity  of 
the  organs.  Dr.  Robei't  Tliaxter , of  Dorchester. 

586.  Acute  inflammation  of  the  kidney,  from  a case  of  fracture  of 
the  spine  (No.  139) ; the  bladder,  which  was  gangrenous,  has 
also  been  preserved,  and  the  symptoms  will  be  given  in  con- 
nection with  that  specimen.  The  disease  affected  about  one- 
half  of  the  cortical  substance,  the  inflamed  portions  being  well- 
defined,  and  characterized  by  an  increased  vascularity,  and  by 
the  effusion  of  lymph  and  pus,  the  substance  of  the  organ 
being  otherwise  healthy.  The  inner  surface  of  the  pelvis  was 
of  a dark  red  color,  and  distended  with  a thin,  dirty  fluid,  as 
was  also  the  ureter,  this  last  being  much  enlarged,  and  the 
cellular  membrane  about  it  indurated.  The  other  kidney  was 
still  more  diseased. 

587.  Three  large  cysts  in  the  kidney,  the  organ  being  otherwise 
apparently  healthy. 

588.  Encysted  disease  of  the  kidney,  the  whole  organ  being  affected 
and  considerably  enlarged,  as  in  a specimen  which  has  been 
figured  by  Cruveilhier.  (Livrais.  vi.  pi.  4.)  From  a patient  of 
Dr.  Charles  G.  Putnam  ; a lady  about  sixty  years  of  age ; had 


URINARY  ORGANS. 


181 


had  strangury,  with  pain  in  the  loins,  for  some  years  before 
death;  for  the  last  few  months  the  urine  was  sometimes 
retained,  and  sometimes  scanty  and  bloody,  the  pain  being 
much  aggravated. 

589.  Encysted  disease  of  the  kidney.  Both  of  the  organs  were 
similarly  affected,  and  so  completely  disorganized  that  no  trace 
of  the  cortical  nor  tubular  portions  could  be  found,  the  struc- 
ture being  nearly  uniform.  The  cysts  were  generally  about 
one  or  two  lines  in  diameter,  but  varied  much  in  size,  and  some 
would  have  held  from  one  to  four  ounces;  fluid  generally 
clear,  but  in  some  of  the  larger  cysts  it  was  rather  dark  and 
turbid.  The  organs  contained  so  little  blood  as  to  appear 
nearly  colorless,  and  being  very  much  enlarged,  they  formed 
upon  each  side  of  the  spine  a prominent  object  when  the  abdo- 
men was  first  opened,  resembling  somewhat,  from  their  want 
of  color,  translucency,  and  coarsely  granulated  surface,  two 
large  masses  of  boiled  sago.  The  pelvis  and  infundibula  were 
rather  small,  and  did  not  communicate  with  any  of  the  cysts. 
One  of  the  organs  has  been  preserved,  and  cut  open  so  as  to 
show  its  internal  structure.  In  the  liver,  also,  were  found  a 
number  of  cysts,  varying  from  one  to  twelve  lines  in  diameter ; 
their  contents,  also,  varied  much,  some  being  filled  with  clear 
serum,  and  others  with  a viscid,  milky,  or  purulent  fluid,  the 
inner  surface  being  smooth  and  polished,  and  the  organ  being 
otherwise  healthy. 

From  a patient  of  Dr.  John  Ware  ; a young  man,  nineteen 
years  of  age,  and  who  had  always  been  subject  to  excessive 
thirst  and  to  a copious  discharge  of  urine.  From  infancy  he 
was  accustomed  to  drink  great  quantities  of  water,  and  suffered 
so  much  when  deprived  of  it  that  he  would  sometimes  drink 
the  dirty  water  from  a wash-basin.  During  the  last  five  years  he 
had  several  attacks,  which  may  have  been  owing  to  the  disease 
of  the  liver.  About  a month  before  his  death  the  respiration  was 
observed  to  be  hurried  and  panting,  continuing  the  same  when 
at  rest  or  asleep,  but  this  symptom  he  did  not  notice  himself. 
Two  weeks  afterwards,  when  Dr.  W.  was  first  called  to  see 
him,  the  dyspnoea  was  the  prominent  symptom ; he  was  then 
listless  and  pale,  and  his  countenance  had  at  times  a deathly 
aspect ; complained  of  pains  in  the  limbs,  which  he  called 


182 


URINARY  ORGANS. 


cramps ; had  some  palpitation  and  cough,  and  the  sound  of 
respiration  was  very  loud;  stomach  and  bowels  sufficiently 
well ; no  affection  of  the  head.  The  urine  was  copious,  clear, 
frothy,  of  a light  straw  color,  coagulating  moderately  when 
heated,  and  becoming  milky  on  the  addition  of  nitric  acid. 
From  this  time  there  was  no  material  change  in  the  symptoms ; 
the  flesh,  strength,  and  appetite  gradually  failed,  and  the 
breathing  became  more  rapid  and  laborious,  so  as  to  become 
painful  to  witness,  though  the  patient  himself  did  not  complain 
of  it,  but  rather  of  the  pain  in  his  knees,  which  was  sometimes 
very  severe.  The  urine  increased  in  quantity,  but  the  thirst 
was  not  very  great.  Came  down  stairs  until  a week  before 
death.  For  the  last  two  days  there  was  partial  stupor,  with 
some  delirium,  though  he  was  rational  at  intervals,  the  quantity 
of  urine  diminishing  on  the  last  day.  The  peculiar  respiration 
in  this  case  was  supposed  by  Dr.  W.  to  be  owing  to  a deterio- 
ration of  the  blood  produced  by  the  disturbed  function  of  the 
kidneys. 

590.  Section  of  a kidney,  which  was  much  enlarged  and  almost 
perfectly  bloodless,  with  opaque,  yellowish  points  in  the  corti- 
cal substance,  as  from  an  albuminous  deposit.  The  organ 
weighed,  when  recent,  twelve  ounces,  and  measured  six  inches 
in  length.  From  a patient  of  Dr.  J.  G.  Stevenson;  a tall, 
stout  man,  who,  after  having  recovered  from  a febrile  attack, 
became  affected  with  cedema  of  the  lower  extremities  and  of 
the  face,  with  ascites ; was  relieved  for  a time,  but  soon  became 
worse  again,  and  died  in  about  six  months  from  the  first  of 
his  sickness.  (See  next  specimen.) 

591.  Atrophy  of  the  kidney.  Very  little  of  the  original  texture 
remains,  the  weight  of  the  organ,  when  recent,  being  one 
ounce,  and  the  length  one  inch.  From  the  same  subject  as 
the  last  specimen.  In  a very  strongly  marked  case  of  Bright’s 
disease  of  the  kidney,  which  occurred  at  the  Mass.  Gen.  Hos- 
pital about  this  time,  the  atrophy  of  one  of  the  organs  was  still 
more  remarkable. 

592.  Very  extensive  tuberculous  disease  of  the  kidney,  three  or 
four  large  cavities  communicating  with  the  pelvis,  and  in  some 


URINARY  ORGANS. 


183 


places  almost  the  entire  substance  of  the  organ  being  destroyed. 
The  cavities  were  coated  thickly  upon  the  inner  surface  with  a 
curdy,  tuberculous-looking  deposit,  and  the  same  extended 
down  the  ureter;  in  the  bladder  also  there  was  .extensive  ulcer- 
ation, with  a few  tubercles,  as  seen  in  the  preparation,  the 
appearance  of  the  kidney  corresponding  perfectly  with  the 
figures  given  by  Dr.  Baillie  and  by  Dr.  Carswell  of  this  form 
of  disease.  Besides  this  affection  of  the  kidney,  there  was 
also  extensive  tuberculous  disease  of  the  lungs,  with  ulceration 
of  Peyer’s  glands.  The  patient,  a middle-aged  woman,  com- 
plained of  pains  in  the  pelvis,  with  dysuria  for  three  years  before 
death;  from  these  symptoms  she  was  for  a time  relieved,  but 
they  soon  returned,  with  leucorrhcea,  and  continued  until  six 
months  before  her  death,  when  disease  of  the  lungs  appeared, 
and  from  that  time  all  trouble  about  the  pelvis  ceased. 

Several  cases  of  this  kind  have  been  observed  here,  the 
disease  of  the  kidneys  being  very  extensive,  and  of  long  dura- 
tion, as  shown  by  the  symptoms,  whilst  the  affection  of  the 
lungs,  though  sometimes  quite  extensive,  was  evidently  more 
recent. 

593.  Carcinoma  of  the  kidney.  The  patient,  a man,  forty-nine 
years  of  age,  had  generally  enjoyed  good  health,  but  for  the 
last  fourteen  years  had  been  subject  to  epilepsy.  Six  or  eight 
weeks  before  death  he  had  a fit  of  unusual  severity,  which  was 
followed  by  marked  cerebral  symptoms,  and  he  died  comatose 
and  paralytic,  disease  of  the  kidneys  never  having  been  sus- 
pected. In  the  brain  and  lungs  were  some  diseased  masses, 
probably  carcinomatous.  The  liver  and  right  kidney  were 
healthy.  The  left  kidney  weighed  eighteen  ounces,  and  was 
nearly  seven  inches  in  length.  The  inferior  portion  was  com- 
pletely disorganized,  and  consisted  of  a coarse  areolar  tissue, 
a semi-translucent  deposit,  and  some  opaque,  tuberculous-look- 
ing matter,  such  as  is  often  found  in  carcinomatous  masses,  the 
whole  being  quite  firm.  The  upper  portion  contained  some 
well  marked  encephaloid  deposit,  with  effused  blood,  besides 
one  or  two  large  cysts.  One  half  of  the  organ  has  been  pre- 
served. 1838. 

594.  Carcinoma  of  the  kidney.  Both  of  the  organs  were  enlarged, 


184 


URINARY  ORGANS. 


firm,  and  lobulated  on  the  surface,  but  retained  their  polish, 
when  the  external  tunic  was  stripped  off.  On  making  a single 
longitudinal  section  through  each  of  them,  not  a trace  of  corti- 
cal substance  was  to  be  seen,  but  in  its  place  an  opaque,  white, 
smooth,  homogeneous  structure,  with  slight  traces  of  effused 
blood  upon  the  external  surface ; a few  only  of  the  tubular 
portions  remained  healthy.  The  same  disease  was  found  very 
extensively  throughout  the  abdomen.  (See  specimen  507.) 
From  a patient  of  Dr.  Charles  G.  Putnam;  a little  girl,  six 
years  of  age,  who  had  been  sick  for  about  a year,  but  had  never 
any  symptoms  which  were  referred  to  the  kidneys.  1840. 

ii.  Renal  Capsules. 

595.  Ossification  of  the  renal  capsules,  the  result,  probably,  of 
tuberculous  disease  of  these  organs,  specimens  of  which  have 
been  exhibited  to  the  Society.  The  lungs  and  bronchial 
glands  were  perfectly  healthy.  A dry  specimen.  From  a 
young  woman,  who  died  of  typhoid  fever.  1840. 

Dr.  J.  B.  S.  Jackson. 

596.  A large,  encysted  tumor  in  the  situation  of  the  left  renal  cap- 
sule. The  patient  was  forty  years  of  age,  and  died  of  erysip- 
elas, at  the  Mass.  Gen.  Hospital,  after  the  removal  of  a cancer 
of  the  breast,  having  had  the  disease  for  two  years  and  a half. 
About  ten  months  before  death  she  first  perceived  a tumor 
below  the  left  hypochondrium ; this  increased  somewhat,  and, 
on  examination,  was  found  to  be  of  considerable  size,  but  was 
not  tender,  and  neither  was,  nor  ever  had  been  painful.  The 
tumor  adhered  closely  to  the  left  kidney,  this  last  being  rather 
small,  but  quite  healthy  in  structure  ; together,  they  weighed 
two  pounds  and  eleven  ounces.  The  cyst  was  of  a regular, 
rounded  form,  and  as  large  as  the  two  fists,  consisting  of  a 
dense,  white,  fibro-cellular  structure,  from  one  or  two  to  eight 
lines  in  thickness.  The  cavity  was  mostly  filled  with  a soft, 
curdy  substance,  of  a dirty,  greyish  or  brownish  color:  it  con- 
tained, also,  § x.  of  a watery  fluid,  which  escaped  when  the  sac 
was  first  opened.  The  inner  surface  was  regular,  being  in 
some  parts  smooth  and  polished,  in  others  yellow  and  almost 
coriaceous,  like  the  gizzard  of  a bird,  with  here  and  there 


URINARY  ORGANS. 


185 


patches  of  a white,  chalky-looking  deposit.  The  left  extremity 
of  the  pancreas,  and  a portion  of  the  colon,  adhered  firmly  to 
the  tumor.  No  appearance  of  malignant  disease  in  any  of  the 
organs.  The  kidney  is  preserved  in  connection  with  the  cyst. 
May  26th,  1843. 

in.  Pelvis  and  Ureter. 

597.  A mould  in  wax,  showing  a great  dilatation  of  the  pelvis  of  the 
kidney,  the  ureter  at  its  commencement  being  of  the  natural 
size  and  pervious.  The  kidney  was  in  some  parts  extremely 
thin,  and  bulged  out  externally,  as  usual  in  these  cases ; a 
small  calculus  was  felt  in  the  pelvis  before  it  was  injected. 
The  other  kidney  was  affected  with  Bright’s  disease.  From  a 
man,  sixty-three  years  of  age,  who  died  of  pneumonia  at  the 
Mass.  Gen.  Hospital.  January  31st,  1846. 

598.  The  pelvis  of  the  kidney  of  a Mink,  ( Putorius  vison)  distended 
by  strongyli ; the  parasites  have  been  preserved,  and  will  be 
noticed  in  their  proper  place.  The  organ  itself  is  somewhat 
enlarged,  and  reduced  to  a mere  cyst.  Upon  its  inner  surface 
is  a slender  piece  of  bone,  two-thirds  of  an  inch  in  length, 
with  long,  narrow,  curved,  and  parallel  slips,  going  off  from 
each  side,  like  ribs  from  the  spine.  Ureter  pervious.  The 
whole  urinary  and  genital  apparatus,  having  been  dissected  out 
by  Dr.  Erasmus  D.  Miller,  of  Dorchester,  has  been  preserved, 
and  seems  to  be  otherwise  healthy.  1834. 

Since  the  above  specimen  was  sent,  Dr.  M.  has  met  with  five 
or  six  other  cases,  all  of  which  perfectly  resembled  the  one 
just  described,  except  that  the  bone  was  not  again  found.  In  a 
specimen,  however,  which  was  examined  in  this  city,  there 
was  found  in  one  of  the  kidneys  a single  worm,  twenty-three 
inches  in  length,  and  upon  the  inside  of  the  cyst  a bone,  which 
very  nearly  resembled  the  one  in  Dr.  M.’s  specimen.  In  every 
case  the  animal  itself  appeared  to  be  healthy. 

599.  Great  dilatation  of  the  ureter  and  kidney,  as  represented  by 
Cruveilhier,  (Liv.  xxvii.  pi.  2.)  The  ureter  was  so  large  as  to 
have  been  mistaken  for  the  intestine,  and,  as  such,  was  cut 
across  near  its  lower  termination.  The  kidney  externally  was 

24 


186 


URINARY  ORGANS. 


rather  small,  bulging  out  here  and  there,  and  feeling  like  a 
mere  cyst.  From  a dissecting-room  subject;  cause  of  the 
dilatation  not  observed.  Having  been  inflated  and  dried,  a 
portion  of  the  kidney  has  been  cut  away,  showing  the  extreme 
thinness  of  the  organ,  and  that  the  external  protuberances  cor- 
respond to  the  infundibula.  Dr.  O.  W.  Holmes. 

600.  Ureter  dilated  to  about  the  size  of  the  little  finger. 

601.  Ureter  dilated  to  within  two  inches  and  a half  of  the  bladder, 
and  then  abruptly  contracted  from  the  size  of  the  thumb  to 
about  the  usual  size ; a dry  specimen.  The  pelvis  of  the 
kidney  was  dilated,  and  the  organ  atrophied.  From  a man, 
who  had  suffered  for  some  time  from  frequent  micturition,  and 
died  at  the  Mass.  Gen.  Hospital,  of  apoplexy.  June,  1846. 

Dr.  J.  B.  S.  Jackson. 

iv.  Bladder. 

602.  Foetal  bladders,  distended  and  dried  ; the  age  marked  on  each. 

Dr.  J.  B.  S.  Jackson. 

603.  A peculiar  form  of  the  bladder,  the  base  being  dilated  laterally, 
and  the  fundus  rather  contracted.  From  a man  who  died  at 
the  Mass.  Gen.  Hospital,  of  phthisis.  June,  1846. 

Dr.  J.  B.  S.  Jackson. 

604.  Extensive  inflammation  and  gangrene  of  the  bladder,  from  a 
case  of  fracture  of  the  spine,  (No.  139.)  There  was  paralysis 
of  the  organ,  and  after  the  first  few  days  pain  with  tenderness 
in  the  hypogastrium,  and  a discharge  of  blood,  mucus,  and  pus 
with  the  urine,  which  was  very  foetid.  Externally,  the  bladder 
appeared  somewhat  enlarged,  and  was  very  thick  and  firm  to 
the  feel.  Cavity  filled  with  coagulated  blood  and  pus,  the 
whole  being  excessively  foetid.  Fundus  and  posterior  portion 
comparatively  healthy,  the  muscular  coat  being  thickened,  but 
the  inner  surface  nowhere  red.  Anteriorly,  the  mucous  coat 
was  extensively  destroyed,  the  portion  which  remained  being 
separated  from  the  subjacent  pails,  or  hanging  off  in  gangren- 
ous shreds;  in  some  parts  the  muscular  coat  formed  the 


URINARY  ORGANS. 


187 


inner  surface,  but  to  a considerable  extent  this  also  was 
destroyed ; thick,  whitish  pus  was  effused  between  all  of  the 
tissues,  and  between  the  bladder  and  symphisis  pubis  there 
was  an  abscess  of  some  size.  General  appearance  of  the 
diseased  surface  rough  and  whitish.  For  inflammation  of  the 
kidneys  in  this  case  see  specimen  No.  586. 

605.  A preparation,  to  show  the  condition  of  the  bladder  which  is 
sometimes  observed  in  a case  of  calculus.  The  organ  in  the 
recent  state  was  dark  colored,  small,  and  thickened,  but  towards 
the  outlet  was  dilated  into  a large  cavity,  regular  in  its  outline, 
quite  thin,  well  defined,  and  containing  the  great  mass  of  the 
largest  of  two  calculi,  which  were  contained  in  the  bladder  and 
will  be  hereafter  described,  a division  in  the  calculus  corres- 
ponding with  the  limits  between  the  muscular  and  the  saccu- 
lated portions  of  the  organ.  Cruveilhier  figures  (Liv.  xxxvi.) 
a similarly  formed  renal  calculus,  of  which  the  head  and  body 
are  contained  in  different  cavities,  the  neck,  as  he  calls  it,  cor- 
responding to  the  septum  which  divides  them.  Upon  the  inner 
surface  of  the  thin  portion  of  the  bladder,  posteriorly,  were 
several  distinct  orifices,  one  of  which,  at  least,  opened  freely 
into  one  of  the  vesiculas  seminales,  and  some  of  the  others 
may  have  been  the  ducts  of  the  prostate  gland,  though  no 
trace  of  this  body  could  be  found.  Upon  the  median  line, 
posteriorly,  of  the  thin  portion  of  the  bladder,  and  not  far  from 
the  orifices  just  mentioned,  was  a very  prominent,  fleshy,  little 
body,  which  corresponded  with  an  equally  marked  depression 
in  the  calculus,  and  which  was  regarded  as  the  verumontanum, 
though  it  was  far  from  the  proper  commencement  of  the 
urethra,  and  had  none  of  the  orifices  perceptibly  opening  upon 
it.  With  regard  to  this  sacculated  condition  of  the  bladder,  it 
may  have  been  owing  to  a dilatation  of  the  parts,  and  an 
atrophy  of  the  prostate  gland,  or  to  the  process  of  ulceration, 
the  direct  opening  into  one  of  the  vesicul®  seminales  being  in 
favor  of  this  last  view  of  the  case.  The  disease  extended  from 
the  bladder  up  the  ureters  to  the  kidneys,  the  lining  membrane 
of  these  organs  being  red  and  thickened,  and  their  cavities 
dilated  and  filled  with  pus.  From  a case  of  old  injury  of  the 
spine.  (No  142.) 


188 


URINARY  ORGANS. 


606.  Sacculated  bladder.  The  organ  itself  is  not  remarkable, 
except  for  a thickening  of  the  muscular  coat,  but  connected 
with  it  posteriorly  is  a cavity,  which,  in  the  recent  state,  must 
have  held  from  one  to  two  quarts.  The  two  cavities  having 
been  inflated  and  dried,  and  the  posterior  one  cut  open,  there 
is  seen  to  be  a direct  communication  between  the  two,  of  an 
oval  form,  and  about  one  inch  and  a half  in  length ; a similar 
specimen,  except  that  the  opening  is  much  smaller,  is  figured 
by  Dr.  Baillie.  The  specimen  was  sent  in  its  present  condi- 
tion to  the  Society,  by  Dr.  Ruel  Burrows,  of  Fryeburgh,  Maine, 
and  with  it  the  following  history  of  the  case : — 

“ The  man  from  whom  this  bladder  was  taken  died  about 
the  year  1824,  and  at  the  age  of  sixty-one  years,  I think;  had 
been  very  feeble  for  many  years,  and  unable  to  labor.  For 
two  or  three  years  previous  to  his  death,  he  told  me  “he 
looked  like  a woman  six  or  seven  months  advanced  in  preg- 
nancy.” Before  that  period  he  said  “ he  was  much  smaller, 
though  he  knew  his  water  came  from  some  place  besides  his 
bladder”  (to  use  his  own  expression)  for  he  found  by  altering 
his  position  after  the  first  discharge,  the  water  ran  freely  and 
“ he  often  made  a quart  the  second  trial.”  The  rectum  was 
nearly  closed  by  mechanical  pressure,  but  this  did  not  occasion 
his  death,  his  whole  system  being  thoroughly  impregnated  with 
urine,  which  destroyed  the  functions  of  the  stomach  and  bowels 
for  the  last  year  of  his  life,  so  that  he  said  “ he  could  taste 
nothing  but  his  urine  let  him  eat  what  he  pleased.” 

607.  Fungous  excrescences  from  the  inside  of  the  bladder,  being 
probably  the  form  of  disease  which  has  been  compared  by 
Wilson  to  the  appearance  of  the  placental  vessels  unravelled. 
The  largest,  situated  just  above  the  opening  of  the  right  ureter, 
was  two  inches  in  diameter,  and  had  a pedicle  of  one-third  of 
an  inch  or  more ; nearly  one-half  of  the  mass  was  of  so  deli- 
cate a structure  that  it  could  only  be  examined  under  water, 
consisting  of  loose,  floating  fibres,  about  one-third  of  a line  in 
width,  flattened,  bearded  on  the  edges  like  the  feathers  of  a 
quill,  and  of  a bright  red  or  scarlet  color,  which  last  they  have 
of  course  lost  since  the  specimen  has  been  in  spirit.  The 
central  portion  had  a white,  opaque,  and  cerebriform  appear- 
ance, and  in  the  pedicle  were  enlarged  blood-vessels.  Two 


URINARY  ORGANS. 


189 


other  excrescences  were  situated  just  at  the  neck  of  the  bladder ; 
one,  about  as  large  as  the  top  of  the  finger,  resembled  the  first 
in  structure ; the  other,  which  was  considerably  smaller,  and 
was  supposed  to  be  a more  recent  formation,  consisted  entirely 
of  the  flocculi,  without  any  of  the  white  central  structure. 
The  bladder  is  seen  to  be  enlarged,  and  the  muscular  coat 
thickened,  the  inner  surface  being  covered,  when  recent,  with 
a reddish,  creamy  fluid.  The  patient  was  a laboring  man, 
forty  years  of  age ; had  been  troubled  with  dysuria  for  some 
years,  and  for  the  last  year  had  occasionally  discharged  coagu- 
lated blood;  had  also  pain  along  the  urethra.  Entered  the 
House  of  Industry  with  cholera,  and  died  in  twenty-four  hours, 
passing  his  urine  frequently  during  that  time,  but  without  pain. 
1836. 

608.  Malignant  disease  of  the  bladder.  From  a patient  of  Dr. 
George  Hayward;  a gentleman,  forty-three  years  of  age,  who 
died  of  very  extensive  encephaloid  disease  within  the  abdomen. 
Just  at  the  opening  of  the  urethra  are  two  rounded,  peduncu- 
lated masses  of  the  same  substance,  projecting  into  the  cavity 
of  the  bladder,  one  above  and  the  other  below  the  opening; 
they  are  about  the  size  of  English  walnuts,  and  are  partially 
encrusted  with  a deposit  from  the  urine.  Organ  otherwise 
healthy.  1837. 

v.  Foreign  Substances,  Calculi,  &c. 

609.  Two  pieces  of  carious  bone,  passed  from  the  urethra ; each 
of  them  measures  about  two  and  a half  by  one  and  a half  lines, 
and,  being  arrested  at  the  orifice  of  the  urethra,  were  removed 
by  a slight  incision.  The  patient,  a boy,  about  fourteen  years 
of  age,  had  had  for  several  years  disease  of  the  hip,  with 
abscesses  about  the  upper  and  under  part  of  the  thigh,  which 
opened  in  different  places,  small  pieces  of  bone  being  occa- 
sionally discharged.  Was  not  confined  to  the  house,  and 
never  had  any  signs  of  infiltration  of  urine.  The  fragments 
of  bone  were  passed  between  one  and  two  years  since,  and  the 
patient’s  health  is  now  much  improved.  January,  1843. 

Dr.  Henry  I.  Bowditch. 


190 


URINARY  ORGANS. 


610.  A pen-holder,  four  inches  and  a half  in  length,  which  was  passed 
into  the  bladder  by  a boy  fourteen  years  of  age,  and  was  removed, 
after  much  difficulty,  by  means  of  the  urethral  forceps.  The 
case  occurred  in  March,  1846.  Dr.  W.  was  called  upon  on 
the  third  day,  and  found  the  patient  in  great  suffering,  with 
incontinence  of  urine,  and  occasional  discharges  of  blood; 
through  the  rectum  the  foreign  body  could  be  distinctly  felt, 
one  extremity  being  just  within  the  urethra,  and  the  other 
apparently  at  the  fundus  of  the  bladder.  The  pen-holder  is 
of  about  the  usual  size,  made  of  bone,  and  quite  smooth.  1847. 

Dr.  J.  Mason  Warren. 

611.  A portion  of  a catheter,  which  was  broken  off  in  the  bladder; 
it  is  three  inches  and  a half  in  length,  and  there  is  formed 
upon  it,  midway,  a soft,  brownish  calculus,  about  as  large  as 
the  end  of  the  thumb.  The  patient  was  a healthy  farmer, 
eighty-three  years  of  age.  In  May,  1841,  having  had  dysuria 
for  some  months,  there  came  on  retention  of  urine,  for  which 
the  catheter  was  required  ; a small  sized  instrument  was  passed 
daily  until  about  the  first  of  June,  when,  on  using  considerable 
force,  something  was  felt  to  give  way,  and,  on  withdrawing  the 
instrument,  it  was  found  to  have  been  broken  off  at  the  curve. 
A larger  one  was  then  passed  without  difficulty,  and  with  it  the 
piece  of  the  broken  catheter  was  distinctly  felt  in  the  bladder. 
For  another  month  the  urine  was  drawn  off  twice  daily,  after 
which  it  was  expelled  by  the  natural  efforts,  and  the  patient 
gradually  regained  his  health,  so  as  to  be  able  to  do  light  work 
on  his  farm,  the  urine,  meanwhile,  being  passed  frequently, 
and  depositing  a thick,  ropy  sediment.  On  the  ninth  of  De- 
cember he  was  attacked  with  febrile  symptoms,  nausea,  and 
vomiting,  pain  in  the  bowels,  with  constipation,  and  a partial 
retention  of  urine ; the  fever  continued,  with  great  prostration, 
an  involuntary  discharge  of  urine,  and  pain,  and  he  died  on  the 
seventh  of  January.  On  dissection,  the  bladder  was  found 
much  thickened  and  discolored,  and  there  was  observed  exter- 
nally one  small  blue  spot  through  which  the  catheter  penetrated, 
on  taking  hold  of  the  organ  to  feel  for  the  instrument ; there 
was,  however,  no  peritonitis ; prostate  gland  enlarged.  This 
case  occurred  in  the  practice  of  another  physician,  but  the 


URINARY  ORGANS. 


191 


specimen  was  presented  to  the  Society,  with  the  above  history 
of  the  case,  by  the  late  Dr.  Henry  Tuck , of  Barnstable. 

612.  Calculus  formed  about  the  barrel  of  a quill.  The  following  is 
an  abstract  of  a history  of  the  case  which  was  sent  with  the 
specimen  by  the  attending  physician:  — On  the  4th  of  August, 
1842,  Dr.  W.  was  called  to  a married  woman,  about  forty 
years  of  age,  and  found  her  flooding  profusely  from  an  abor- 
tion which  had  just  taken  place,  and  which  she  had  procured,  as 
she  afterwards  stated,  by  introducing  the  barrel  of  a goose-quill, 
the  instrument  slipping  from  her  fingers  and  not  being  again 
seen.  The  dysuria,  which  came  on  at  once,  soon  became 
excessively  severe,  and  so  continued  until  the  cause  was 
removed  ; the  nature  of  the  case  was  obvious,  but  both  the 
patient  and  her  husband  were  indignant  at  the  idea  of  a mis- 
take having  been  made,  and  insisted  that  the  quill  was  in  the 
uterus.  On  the  20th  of  the  following  October,  being  felt  in 
the  bladder,  an  attempt  was  made  to  extract  it ; it  was  after- 
wards attempted  to  remove  it  by  dilating  the  urethra,  but  the 
parts  were  very  tender,  and  both  of  these  operations  failed. 
On  the  26th  of  November  the  urine  began  to  pass  involuntarily, 
and  on  the  28th,  a hard  substance  presenting  itself  at  the  orifice 
of  the  urethra,  was  seized  with  a pair  of  common  dressing 
forceps,  and  the  entire  specimen,  as  now  seen,  was  extracted, 
with  perfect  relief  to  all  the  symptoms.  The  quill  is  two 
inches  in  length.  The  calculus,  which  has  formed  about  its 
small  extremity,  and  is  still  firmly  attached,  is  about  as  large 
as  the  last  joint  of  the  fore-finger,  measuring  fourteen  lines  in 
length  and  eight  and  a half  in  diameter ; it  is  of  a regular, 
ovoid  form,  granulated  on  the  surface,  of  a brownish  color, 
and  consists,  according  to  an  analysis  made  by  Dr.  Charles  T. 
Jackson,  of  the  urate  of  ammonia  and  the  phosphate  of  lime 
and  magnesia. 

Dr.  Timothy  Wellington , of  West  Cambridge. 

613.  Uric  acid,  deposited  in  the  form  of  a fine  red  sand,  and  more 
or  less  crystalline ; analyzed  by  Dr.  Martin  Gay.  From  a 
woman,  forty  years  of  age,  who  had  had  much  trouble  at  the 
stomach,  and  particularly  a sense  of  burning,  for  the  last  two 
years.  Urine  turbid,  and  somewhat  diminished,  depositing 


192 


URINARY  ORGANS. 


sometimes  a greyish,  sometimes  a blackish  sediment,  and  often 
a red  sand,  as  seen  in  the  present  specimen.  1847. 

Dr.  Thomas  Spar  hawk,  of  Amesbury. 

614.  A collection  of  very  small  calculi,  which  consist,  according  to 
an  analysis  made  by  Dr.  Charles  T.  Jackson,  of  nearly  pure 
uric  acid.  They  are,  on  an  average,  about  half  a line  in  diam- 
eter, of  a light  brown  color,  rounded  form,  botryoidal  upon  the 
surface,  and  now  sufficiently  consistent,  though,  when  recent, 
they  were  quite  soft ; in  amount,  there  would  have  been  alto- 
gether nearly  a tea  spoonfull.  From  the  urinary  bladder  of  an 
old  woman,  who  died  of  extensive  ovarian  disease ; a patient 
of  Dr.  John  Homans. 

When  nothing  is  stated  to  the  contrary,  it  may  be  understood 
that  the  calculi  were  removed  from  the  urinary  bladder  after 
death. 

615.  A second  collection,  very  similar  to  the  last,  except  that  the 
color  is  lighter;  consist  principally  of  uric  acid  and  animal 
matter,  according  to  an  analysis  made  by  Mr.  Joseph  Peabody, 
a student  of  chemistry  in  Dr.  Charles  T.  Jackson’s  laboratory. 
From  a man  past  the  middle  period  of  life,  who  had  been  dys- 
peptic and  generally  out  of  health  for  several  years,  these 
small  calculi  being  often  passed.  1847. 

Dr.  Woodbridge  Strong. 

616.  A well  characterized  uric  acid  calculus,  two  inches  in  length, 
of  a flattened  oval  form,  reddish  brown  color,  compact  in 
structure,  finely  tuberculated  upon  the  surface,  and,  on  being 
sawed  open,  shown  to  be  formed  in  concentric  layers.  Ana- 
lyzed by  Dr.  Gay;  uric  acid,  with  a trace  of  some  urate. 

The  patient  was  an  Italian  cook,  sixty-two  years  of  age ; in 
the  summer  of  1839  he  was  in  the  Mass.  Gen.  Hospital,  suf- 
fering very  severely  from  dysuria,  with  great  local  irritation, 
and  much  constitutional  affection,  the  symptoms  having  been 
coming  on  for  two  years;  on  the  day  after  his  admission  a 
catheter  was  passed,  but  nothing  was  ever  reported  in  regard 
to  a calculus  ; urine  sometimes  high  colored,  depositing  a sedi- 
ment, and  at  other  times  quite  pale.  On  the  7th  of  April,  1S39. 
he  was  attacked  with  pneumonia,  and,  after  he  had  been  sick 


URINARY  ORGANS. 


193 


for  ten  days,  he  first  complained  of  difficulty  in  passing  his 
urine ; a catheter  was  then  introduced , and  the  calculus  was 
distinctly  felt;  his  distress  from  this  source  lasted  for  a few 
days,  then  subsided,  and  did  not  again  recur  until  three  days 
before  his  death,  the  urine,  meanwhile,  being  clear,  and  with- 
out sediment.  Died  on  the  6th  of  May.  The  bladder  was 
firmly  contracted  about  the  calculus,  and  the  inner  surface  was 
covered  with  a thin,  dirty  mucus.  Dr.  Charles  E.  Ware. 

617.  Two  pear-shaped  calculi,  more  than  half  as  large  as  the  last 
joint  of  the  finger,  and  remarkable  for  their  similarity  in  form 
and  external  appearance.  Analyzed  by  Mr.  Peabody ; chiefly 
uric  acid,  combined  with  the  coloring  matters  which  generally 
exist  in  the  urine ; also  small  quantities  of  the  urates  of  soda, 
potash,  and  ammonia.  From  a negress,  about  sixty  years  of 
age,  who  died  from  the  effects  of  a large  fibrous  tumor  of  the 
womb,  and  without  any  known  symptoms  of  calculus.  1844. 

Dr.  Horace  Thurston. 

618.  Calculus  from  the  kidney  of  a man  (Lane)  who  died  of  dis- 
ease of  the  heart,  at  the  Mass.  Gen.  Hospital,  October  19th, 
1836.  It  is  of  a very  dark  and  dull  brown  color  externally, 
and  of  an  irregular  form.  Analyzed  by  Mr.  Peabody  ; mostly 
uric  acid  and  the  urates,  especially  urate  of  ammonia ; a pro- 
jecting portion  having  been  cut  off,  it  is  seen  to  be,  internally, 
of  a lighter  color,  and  there  is  found  a trace  of  the  phosphate 
of  lime. 

619.  A small  calculus,  which,  from  its  cylindrical  appearance,  may 
perhaps  have  formed  in  the  urethra ; it  is  rather  more  than 
half  an  inch  in  length,  of  a reddish  brown  color,  quite  smooth 
and  compact,  and  consists,  according  to  Mr.  Peabody’s  analysis, 
of  uric  acid  and  the  urates,  with  a slight  trace  of  potash,  but  no 
salt  of  lime. 

620.  A flattened,  oval  calculus,  one  inch  and  three-fourths  in  length ; 
sawed  open.  Analyzed  by  Dr.  Gay;  consists  of  uric  acid, 
with  a thin  coating  upon  the  surface  of  oxalate  of  lime,  this 
last  forming  in  several  places  masses  of  from  one  and  a half 
to  four  and  a half  lines  in  diameter ; upon  the  oxalate  is  a 

25 


194 


URINARY  ORGANS. 


somewhat  extensive,  but  very  thin  deposit,  consisting  of  the 
triple  phosphate  with  a trace  of  the  phosphate  of  lime. 

The  subject  of  this  case  was  the  late  Rev.  Dr.  Prince,  of 
Salem.  He  was  eighty-five  years  of  age,  and  began  to  have 
stangury  twelve  or  fourteen  years  before  his  death  ; this  went 
on  increasing,  and  the  irritation  was  such  that  he  was  obliged 
constantly  to  wear  a urinal ; occasionally  bloody  urine,  with 
other  symptoms  of  stone,  though  none  was  ever  detected,  on 
careful  examination ; meanwhile  his  general  health  was  good, 
and  the  urine  was  natural  in  appearance,  except  for  a mucous 
sediment.  About  three  years  before  his  death  he  had  a very 
severe  attack,  with  frequent  and  profuse  discharges  of  blood ; 
lasted  for  several  weeks,  and  nearly  proved  fatal.  For  seven 
or  eight  years  previous  to  this  attack,  he  had  had  so  much 
tenderness  in  the  region  of  the  kidneys  as  to  prevent  his  riding 
in  a carriage  without  great  suffering,  unless  he  inclined  so 
much  to  the  left  side  as  almost  to  assume  the  recumbent  pos- 
ture, when  he  was  comparatively  easy,  but  from  that  time  he 
could  ride  almost  any  distance  without  the  slightest  inconve- 
nience. As  his  strength  ^returned,  his  former  symptoms  left 
him,  and  except  for  an  occasional  retention  of  urine,  he  had 
no  further  trouble  until  three  weeks  before  his  death,  when  the 
fatal  attack  came  on,  the  symptoms  being  the  same  as  in  the 
previous  one. 

On  dissection,  the  bladder  was  found  somewhat  contracted, 
but  still  capable  of  containing  a considerable  quantity  of  fluid ; 
mucous  membrane  highly  inflamed,  and  in  some  parts  ulcerated. 
The  calculus  was  situated  in  the  fundus,  and  was  so  firmly 
grasped  by  the  muscular  coat  of  the  bladder  as  to  require  con- 
siderable force  to  disengage  it,  being,  in  fact,  so  completely 
encysted,  as  to  appear  like  a firm  tumor  attached  to  the  exter- 
nal surface  of  the  bladder.  Prostate  healthy.  Left  kidney 
completely  disorganized ; pelvis  greatly  dilated,  and  upon  the 
inner  surface  inflamed  and  ulcerated,  the  same  disease  extend- 
ing throughout  the  ureter ; right  kidney  and  its  pelvis  much 
less  diseased.  This  case  was  published  in  the  Boston  Med. 
and  Surg.  Journ.  (Dec.  21st,  1836,)  and  the  specimen  was 
sent  to  the  Society  by  Dr.  George  Choate , of  Salem. 

621.  A very  irregular,  compact,  reddish  brown  calculus,  about  an 


URINARY  ORGANS. 


195 


inch  in  diameter,  and  one  fourth  of  an  inch  in  thickness,  and 
which  is  interesting  from  the  appearance  which  it  presents  of 
having  formerly  been  very  much  larger  than  it  now  is,  both  of 
the  surfaces  having  a remarkably  eroded  appearance.  Analy- 
sis by  Dr.  Gay;  uric  acid,  with  a small  quantity  of  phosphate 
of  lime,  and  a trace  of  some  urate ; upon  the  surface  is  a very 
thin  deposit  of  the  oxalate  of  lime.  From  a patient  of  Dr. 
John  Homans ; a gentleman,  who  died  suddenly  from  disease 
of  the  heart,  having  had  no  urinary  symptoms,  so  far  as  was 
known.  The  calculus  was  from  the  pelvis  of  the  left  kidney, 
and  with  it  were  found  two  others,  of  a rich  brown  color,  and 
about  the  size  of  peas,  one  of  them  much  eroded,  but  the  other 
being  entire,  nearly  smooth,  and  with  some  appearance  of* 
facettes.  November,  1843. 

622.  A calculus,  about  the  size  of  a hen’s  egg;  sawed  open. 
Analyzed  by  Dr.  C.  T.  Jackson ; chiefly  uric  acid ; upon  the 
surface  a rough  crust  of  the  mixed  phosphates. 

Dr.  Winslow  Lewis. 

623.  A calculus  about  the  size  of  a goose-egg,  from  a patient  of  the 
late  Dr.  John  Frink,  of  Rutland.  Analysis  by  Dr.  Gay ; in 
the  centre  uric  acid,  with  some  mixture  of  the  phosphates ; 
externally,  the  mixed  phosphates,  with  a small  quantity  of  uric 
acid,  and  urate  of  ammonia.  Removed  by  an  operation  by  Dr. 
F.  several  years  since.  1843.  Dr.  H.  E.  Clap , of  Wrentham. 

624.  A calculus,  about  the  size  of  a pullet’s  egg,  and  of  a rounded 
form,  but  having  upon  one  side  a marked  concavity.  On  being 
sawed  open,  the  most  prominent  objects  are  a dark  central 
nucleus,  and  a purple  color,  which  last  extends  to  some  depth 
below  the  surface.  Analyzed  by  Mr.  J.  Peabody  ; chiefly  uric 
acid,  and  the  urates  of  potash  and  ammonia,  with  some  phos- 
phate of  lime,  and  a very  small  amount  of  the  triple  phosphate ; 
slightly  fusible  ; in  the  nucleus  the  uric  acid  is  in  excess ; the 
purple  color  is  due  to  a mixture  of  uric  acid  with  the  animal 
matter.  From  a man,  sixty-eight  years  of  age,  and  formerly 
a resident  in  this  city ; had  been  dyspeptic  for  twenty  years  or 
more,  and,  for  seven  or  eight  years  before  his  death,  he  had 
suffered  from  his  urinary  disease  to  such  a degree  that  he  was 


196 


URINARY  ORGANS. 


obliged  from  the  first  to  give  up  his  work,  and  remove  into  the 
country.  The  urine  was  turbid,  and  very  offensive,  with  a 
mucous  sediment;  catheter  required  sometimes  as  often  as 
every  half  hour,  the  pain  and  distress  in  the  bladder  being 
greatly  increased  if  the  urine  was  allowed  to  collect.  There 
was  considerable  disease  of  the  inner  surface  of  the  bladder, 
and,  in  the  situation  of  the  “ middle  lobe  ” of  the  prostate,  a 
defined  tumor,  which  corresponded  to  the  concavity  in  the  cal- 
culus, the  gland  itself  being  sufficiently  healthy;  besides  the 
large  calculus,  there  were  four  or  five  others,  which  were  about 
the  size  of  apple  seeds.  The  kidneys  were  also  somewhat 
diseased.  1846.  Dr.  Woodbridge  Strong. 

625.  The  urine  of  a Boa,  consisting  of  a solid,  hard,  white  mass; 
according  to  Muller  the  urine  of  serpents  contains  the  lithates 
of  potash,  soda,  and  ammonia,  but  not  a trace  of  urea. 

Dr.  Charles  T.  Jackson. 

626.  An  irregular  calculus,  from  the  kidney  of  Lieut.  McC.,  who 
died  of  phthisis  at  the  Mats.  Gen.  Hospital,  September  19th, 
1845.  Oxalate  of  lime  and  urate  of  ammonia,  according  to 
Dr.  M.  Gay’s  analysis. 

627.  A calculus,  of  which  about  eight-tenths  consists  of  the  phos- 
phate of  lime,  and  one-tenth  of  the  carbonate  of  lime ; sawed 
open,  and  has  been  analyzed  by  Mr.  J.  Peabody.  It  is  nearly 
as  large  as  a hen’s  egg,  and  was  removed  by  the  operation  of 
lithotomy.  1844.  Dr.  Joshua  B.  Flint , of  Louisville,  Ky. 

628.  A calculus  of  a regular,  flattened,  oval  form,  and  about  the 
size  of  a large  nutmeg ; sawed  open,  and  seen  to  be  deposited 
in  concentric  layers.  Analysis  by  Mr.  Peabody ; phosphate  of 
lime,  with  a large  portion  of  animal  matter,  and  a little  uric 
acid  and  urate  of  ammonia,  but  no  magnesia.  The  surface  is 
covered  with  minute,  sparkling  crystals.  Removed  by  the 
operation  of  lithotomy.  1844. 

Dr.  Joshua  B.  Flint , of  Louisville,  Kentucky. 

629.  A calculus,  of  an  elongated  form,  one  inch  and  three-fourths  in 
length,  and  about  the  size  of  the  fore-finger.  The  surface  is 


URINARY  ORGANS. 


197 


rough,  and,  having  been  sawed  open,  it  is  seen  to  consist  of 
two  portions,  an  oval  calculus,  which  is  formed  of  concentric 
layers,  and  a coarse  amorphous  mass,  which  is  deposited  upon 
one  extremity  of  this  as  a nucleus.  Not  far  from  the  centre 
of  the  nucleus  is  a fine,  deep  green  line,  concentric  with  the 
other  deposits.  Analysis  by  Mr.  Peabody ; phosphate  of  lime ; 
in  the  nucleus  a portion  of  the  urate  of  lime,  urate  of  ammonia, 
and  free  uric  acid,  the  green  lime  being  probably  a colored 
animal  matter.  Removed,  by  the  operation  of  lithotomy.  1844. 

Dr.  Joshua  B.  Flint , of  Louisville,  Kentucky. 

630.  A calculus,  which  was  removed  from  near  the  upper  extremity 

of  a dilated  ureter,  (No.  601)  and  seemed  to  be  adherent  to 
its  inner  surface,  as  were  the  biliary  calculi  in  a case  above 
described,  to  the  inner  surface  of  the  gall-bladder.  It  is  about 
two  lines  in  diameter,  and  is  made  up  of  a group  of  pale  yel- 
lowish, well  marked,  lenticular  crystals,  much  resembling  some 
of  the  crystals  of  carbonate  of  lime ; consists  of  the  phosphate 
of  lime,  according  to  an  analysis  by  Dr.  C.  T.  Jackson.  From 
a man  who  died  of  apoplexy,  at  the  Mass.  Gen.  Hospital, 
June  19th,  1846.  Dr.  J.  B.  S.  Jackson. 

631.  A calculus  about  the  size  of  a pea,  quite  rough,  and  crystal- 
line upon  the  surface.  From  a boy,  seven  years  old,  a patient 
of  Dr.  M.  S.  Perry;  Dr.  P.  was  called  on  account  of  an 
obstruction  to  the  flow  of  the  urine,  and  found  the  calculus  one 
inch  and  a half  from  the  orifice  of  the  urethra ; Dr.  George 
Hayward  was  then  sent  for,  and  the  calculus  was  removed 
without  much  difficulty,  and  by  simply  dilating  the  passage. 
1841. 

632.  A calculus  passed  from  the  urethra.  It  is  of  a flattened  oval 
form,  half  an  inch  in  length,  and  irregularly  crystallized  upon 
the  surface.  Analysis  by  Dr.  Charles  T.  Jackson ; phosphate 
of  lime,  with  a trace  of  magnesia.  The  brown  crust,  which 
partially  covers  the  external  surface,  was  found  to  be  a very 
rare  substance ; it  was  insoluble  in  muriatic  acid ; being  dis- 
solved in  nitric  acid,  diluted,  filtered,  and  evaporated  to  dry- 
ness, it  gave  no  evidence  of  purpurate  of  ammonia ; a yellow 
solution  is  formed  by  the  nitric  acid,  and,  on  adding  ammonia, 


198 


URINARY  ORGANS. 


a lemon  colored  flocculent  precipitate  is  thrown  down,  charac- 
acteristic  of  xanthic  oxide. 

633.  Deposite  from  the  urine  of  the  phosphate  of  ammonia  and 
magnesia;  analyzed  by  Dr.  M.  Gay.  The  patient  (Drew)  was 
sixty  years  of  age,  had  an  enlarged  prostate,  and  died  in  the 
Mass.  Gen.  Hospital  in  the  summer  of  1838. 

634.  Urinary  calculus,  formed  upon  a portion  of  a suspender 


of  the  calculus  has  been  made,  so  as  to  exhibit  the  buckle,  and 
the  whole  has  been  represented  of  full  size  in  the  adjoining  fig- 
ure. It  is  a white,  earthy  looking,  homogeneous  mass,  and 
consists  of  the  mixed  phosphates,  according  to  Dr.  Gay’s 
analysis.  The  patient  was  formerly  an  intelligent  merchant, 
but  became  insane,  entered  the  McLean  Asylum  in  the  year 
1814,  and  remained  in  that  Institution  until  June,  1845,  when 
he  died  at  the  age  of  fifty-nine  years.  He  was  particularly 
remarkable  for  the  pleasure  which  he  seemed  to  take  in  injur- 
ing himself.  Several  years  before  his  death  he  passed  into 
the  urethra  a piece  of  slate,  measuring  one  inch  and  a half  by 
three-fourths  of  an  inch,  but  this  was  removed  by  Dr.  Bell, 
without  making  an  incision,  after  it  had  been  broken  down 
with  a pair  of  forceps.  In  November,  1843,  he  passed  in  a 
ring  from  the  handle  of  a parasol,  or  rather  two-thirds  of  a 
ring,  which,  if  entire,  would  have  measured  two  inches  and 
three-fourths  in  diameter,  and  which  nearly  equalled  the  little 
finger  in  size ; this  he  got  fairly  round  the  pubes,  and  it  was 
removed  by  Dr.  B.  by  an  incision  through  the  perineum,  the 
suspender  buckle  being  in  the  bladder  at  this  very  time,  if  the 
subsequent  statement  of  the  patient  was  correct.  He  gradu- 
ally sank  under  the  irritation  produced  by  the  calculus,  and,  on 
dissection,  the  bladder  was  found  very  much  thickened,  and 


death;  a section 


URINARY  ORGANS. 


199 


the  urethra  dilated  so  as  nearly  to  admit  the  little  finger. 

Dr.  Luther  V.  Bell , Sup’t  of  the  McLean  Asylum. 

635.  Several  calculi  which  were  taken  from  the  bladder  of  a Sper- 
maceti Whale.  Of  thirteen  specimens,  which  were  sent  to 
the  Society,  by  Dr.  Eastham,  in  the  year  1841,  the  largest 
measured  two  inches  and  a half,  and  the  smallest  one  inch  in 
diameter ; otherwise  they  were  remarkably  uniform  in  their 
character,  being  perfectly  white,  of  a fine,  compact  structure, 
very  distinctly  laminated,  and  generally  of  a tetrahedral  form, 
with  well  marked  fafettes ; one  of  them  has  been  sawed  open. 
Analyzed  by  Dr.  Charles  T.  Jackson,  and  found  to  consist  of 
the  phosphate  of  magnesia  and  ammonia,  with  some  phosphate 
of  lime,  the  same  result  having  been  obtained  by  Mr.  Taylor, 
of  London,  in  the  examination  of  a specimen,  which  was  sent 
to  the  Museum  of  the  Royal  College  of  Surgeons. 

Three  large  boxes  of  these  calculi  were  sent  home  to  New 
Bedford,  from  the  South  Sea,  by  Capt.  Paul  Chase,  of  the  ship 
Nassau ; the  whale  was  a very  large  “ old  bull,”  and  so  much 
emaciated  as  to  furnish  but  very  little  oil.  In  the  Museum  at 
Nantucket,  which  was  destroyed  last  year  during  the  extensive 
fire  at  that  place,  there  was  a calculus  from  this  same  subject, 
and  which  perfectly  resembled  those  already  described,  except 
that  it  was  about  as  large  as  the  double  fist ; upon  this  speci- 
men was  a label  which  stated  that  the  weight  of  the  calculi, 
which  were  removed,  amounted  altogether  to  eighty-six  pounds. 

636.  Two  calculi  from  the  bladder  of  a Horse.  They  are  nearly 
as  large  as  the  fist,  and  formed  in  veiy  marked  concentric 
laminse ; the  surfaces  being  smooth,  slightly  concave,  and  of  a 
triangular  form.  One  of  them  has  been  sawed  open.  Analy- 
sis by  Mr.  Moses  B.  Williams,  who  was  formerly  a student 
of  chemistry  in  Dr.  Charles  T.  Jackson’s  laboratory ; consist  of 
the  mixed  phosphates. 

637.  Calculus,  from  beneath  the  prepuce  of  a Hog ; it  is  consider- 
ably larger  than  a nutmeg,  of  a very  regular  rounded  form, 
and  consists,  according  to  an  analysis  by  Dr.  Gay,  of  the 
mixed  phosphates,  no  carbonate  of  lime  being  present.  1829. 

Dr.  John  Ware. 


200 


URINARY  ORGANS. 


638.  Two  calculi,  from  a case  of  old  fracture  of  the  spine  (No.  142). 
One  of  them,  the  form  of  which  is  interesting  in  connection 
with  the  state  of  the  bladder,  is  two  inches  in  length,  and  con- 
sists, as  it  were,  of  a body,  neck,  and  head ; the  body  is  about 
the  size  of  a pullet’s  egg,  the  head  about  equals  a small  filbert, 
and  the  constriction  at  the  neck  is  deep  and  defined.  The 
second  calculus,  which  was  found  resting  upon  the  upper 
extremity  of  the  larger  one,  is  quite  regular  in  its  form  and 
about  the  size  of  a small  nutmeg.  These  calculi  are  white 
externally,  and  more  or  less  so  throughout,  somewhat  crystal- 
lized upon  the  surface,  and  consist  mainly,  according  to  Dr. 
Gay’s  analysis,  of  the  urate  of  ammonia,  with  the  mixed  phos- 
phates, these  last  alone  being  found  towards  the  surface. 

639.  A calculus,  about  the  size  of  a hen’s  egg,  of  a coarse  tex- 
ture, but  with  many  delicate  crystals  upon  the  surface ; 
urate  of  ammonia,  mostly.  From  a patient  of  Dr.  William 
Ingalls ; a case  of  old  injury  of  the  spine  (No.  143),  the  cal- 
culus being  the  immediate  cause  of  death.  The  condition  of 
the  bladder  was  very  similar  to  that  of  one  already  described 
(No.  604),  the  calculus  being  moulded  into  a thin  defined  sac, 
which  had  formed  at  the  neck  of  the  organ.  1842. 

640.  A calculus  about  the  size  of  a hen’s  egg,  and  of  a very  regu- 

lar oblong  form.  Having  been  sawed  open,  there  is  seen  to  be 
a hard,  dark-colored  nucleus  just  beneath  the  surface,  and  con- 
sisting principally  of  the  urate  of  ammonia  and  uric  acid; 
upon  this  there  has  been  deposited  in  successive  layers  a large 
mass,  which  is  partly  hard,  partly  soft  and  crumbling,  and 
which  consists  of  the  subphosphate  of  lime,  and  the  phosphate 
of  magnesia  and  ammonia  in  equal  quantities ; analyzed  by 
Mr.  J.  Peabody.  From  a man  who  died  at  the  Marine  Hospi- 
tal, Chelsea.  Dr.  George  W.  Otis. 

641.  Two  calculi  of  an  oblong  form,  one  of  them  being  nearly  an 
inch  and  a half  in  length;  but  the  other  much  smaller.  From 
an  old  gentleman,  eighty-two  years  of  age,  who  for  two  years 
before  his  death  had  had  urinary  symptoms,  under  which  he 
gradually  sank.  The  kidneys  were  much  disorganized,  and 
the  ureters  distended  and  filled  with  pus.  The  largest  calculus 


URINARY  ORGANS. 


201 


has  been  sawed  open,  and  consists  of  the  mixed  phosphates, 
with  a nucleus  of  the  oxalate  of  lime.  1846. 

Dr.  Robert  Thaxter,  of  Dorchester. 

642.  Fragments  of  a calculus  which  was  removed  by  the  opera- 

tion of  lithotrity,  at  the  Mass.  Gen.  Hospital,  in  the  spring  of 
1846.  The  patient  was  the  mate  of  a vessel,  and  about  six 
months  previously,  whilst  at  sea,  undertook  to  treat  himself  for 
a stricture  of  the  urethra;  as  a substitute  for  a bougie,  a piece 
of  sealing-wax  was  used,  and  when  this  broke  off,  as  might 
have  been  expected,  a portion  of  it  fell  into  the  bladder,  and 
formed  the  nucleus  for  a calculus,  which  must  have  been  about 
the  size  of  an  English  walnut.  Five  or  six  operations  were 
performed,  and  with  entire  relief,  the  foreign  body  coming 
away,  in  a softened  state,  with  those  fragments  which  were  the 
last  to  be  discharged.  1847.  Dr.  J.  Mason  Warren. 

643.  A finely  characterized  mulberry  calculus,  consisting  of  the 
oxalate  of  lime,  with  a thin  and  uniform  coating  over  the  whole 
surface  of  uric  acid ; analyzed  by  Dr.  Charles  T.  Jackson. 
It  is  about  the  size  of  a large  English  walnut,  and,  having 
been  sawed  open,  one-half  has  been  rubbed  down  and  polished. 
Removed  after  death,  from  Dr.  C.  of  Topsfield. 

The  specimen  was  sent  to  the  Society  by  Dr.  Peirson,  with 
the  following  history  of  the  case : — “ Dr.  C.  was  seventy -seven 
years  of  age,  never  had  acute  vesical  symptoms,  and  of  course, 
never  suspected  that  he  had  a stone  in  the  bladder.  He  some- 
times had  pain  in  the  loins  and  thighs,  followed  by  the  discharge 
of  renal  calculi.  On  this  account  he  made  a free  use  of  salse- 
ratus,  and  for  twenty  years  or  more  he  took  it  almost  daily. 
His  health  was  always  most  excellent,  until  within  two  years  of 
his  death,  when  he  had  a pain  in  the  toe  and  foot,  which 
seemed  to  threaten  gangrena  senilis  ; from  this  he  recovered, 
but  was  soon  afterwards  attacked  with  the  gastric  affection,  and 
the  question  arises,  whether  the  salseratus  had  anything  to  do 
with  it.”  1837.  Dr.  A.  L.  Peirson , of  Salem. 

644.  A calculus,  about  the  size  of  a pea,  and  consisting  mostly  of 
the  oxalate  of  lime ; analyzed  by  Mr.  Joseph  Peabody.  Passed 
from  the  urethra,  by  a man  (Leggett)  who  was  a patient  in  the 

26 


202 


FEMALE  ORGANS  OF  GENERATION. 


Mass.  Gen.  Hospital,  with  severe  urinary  symptoms,  in  the 
summer  of  1845. 

645.  A small  calculus  from  the  kidney  of  a Sheep,  one  of  its  three 
faces  having  a beautiful  pearly,  and  somewhat  iridescent  ap- 
pearance. Analyzed  by  Mr.  Peabody ; before  the  blow-pipe  it 
does  not  fuse  nor  decrepitate,  but  burns  white,  and  leaves  an 
alkaline  residuum,  which  is  partly  oxalate  of  lime. 

Dr.  Jeffries  Wyman. 

646.  Saccharine  matter  from  the  urine,  in  a case  of  diabetes  melli- 
tus.  The  patient  was  in  the  Mass.  Gen.  Hospital  in  the  year 
1828 ; a history  of  the  case  by  Dr.  Walter  Channing,  with  a 
full  account  of  the  chemical  analyses  which  were  made  at 
various  times  by  Dr.  Charles  T.  Jackson,  was  published  in  the 
Boston  Med.  and  Surg.  Journ.  (February,  1829.) 

647.  Nitrate  of  urea,  prepared  from  the  urine,  in  the  above  case, 
and  a few  days  only  after  the  sugar  was  obtained. 

Dr.  Charles  T.  Jackson. 

648.  Saccharine  matter  from  the  urine,  in  a case  of  diabetes  mellitus. 

From  a woman,  about  fifty  years  of  age;  had  had  the  disease 
for  twenty  months,  and  died  at  last  of  phthisis,  the  pancreas 
and  both  of  the  kidneys  being  diseased.  A full  history  of  the 
case  was  published  in  the  New  England  Quarterly  Journ.  of 
Med.  and  Surg.  for  July,  1842,  by  Dr.  John  Homans. 


X.  FEMALE  ORGANS  OF  GENERATION, 
i.  Uterus. 

649.  Pelvic  organs  distended  and  dried,  to  show  the  relations  of  the 

uterus.  Dr.  Joseph  Roby. 

650.  Uterus  and  vagina  divided  throughout  by  a longitudinal  septum. 
The  patient  was  an  unmarried  female,  thirty-three  years  of 
age,  and  well  developed,  the  breasts  having  been  rather  unu- 


FEMALE  ORGANS  OF  GENERATION. 


203 


sually  large.  The  catamenia  had  for  a long  time  been  scanty, 
and  for  two  years  before  her  death  the  periods  had  only  con- 
tinued for  about  a day ; their  recurrence,  however,  was  regular  ; 
meanwhile  she  had  many  of  the  symptoms  of  anaemia,  and 
finally  died,  as  it  was  supposed,  of  pneumonia,  although,  on 
dissection,  nothing  was  found  but  a serous  congestion  of  the 
lungs.  The  uterus  was  enlarged,  measuring,  before  being  cut 
open,  two  inches  and  ten  twelfths  in  length,  and,  at  the  fundus, 
two  inches  and  nine  twelfths  in  width,  and  one  inch  and  two 
twelfths  in  thickness.  Anterior  face  slightly  convex ; posteri- 
orly, it  was  slightly  depressed  on  the  median  line,  but  very 
much  less  so  than  in  a similar  case  which  is  represented  by 
Cruveilhier  (Liv.  iv.  pi.  5,  fig.  4.)  The  cavity  was  divided 
into  two  equal  portions  by  a longitudinal  septum,  from  two  to 
three  lines  in  thickness;  arbor  vitse  less  marked  than  usual. 
One  Fallopian  tube  and  ovary  only  on  each  side.  The  vagina 
measured  about  two  inches  in  length  ; septum  continued  from 
the  uterus  to  within  one-third  of  an  inch  of  the  external  labia, 
the  two  canals  being  about  the  size  of  a large  male  catheter 
where  they  open  into  the  vulva,  but  much  larger  towards  the 
uterus.  One  of  these  canals  has  been  cut  open,  and  into  the 
other  a piece  of  whalebone  has  been  passed ; the  uterine  cavi- 
ties are  also  set  open  by  slips  of  whalebone.  1839. 

651.  Bilobated  uterus.  The  right  cornu  is  nearly  in  a continuous 
line  with  the  vagina,  and  seems  to  have  been  the  proper  organ; 
length  fourteen  lines,  and  width  at  fundus  one  inch  ; Fallopian 
tube  and  ovary  normal.  The  left  cornu  goes  off  from  the 
right  at  an  angle  of  45°,  and  is  altogether  less  developed  than 
it;  Fallopian  tube  short,  and  obliterated  at  its  extremity,  and 
in  place  of  the  ovary  is  a cyst  nearly  two  inches  in  diameter, 
all  the  parts  on  this  side  of  the  uterus  being  united  by  old  peri- 
toneal adhesions  when  first  exposed  in  the  dissection.  Cervix 
and  os  uteri  single  and  well  formed.  Upon  the  posterior  median 
line  of  the  vagina  is  an  appearance  as  if  there  had  formerly 
been  a septum,  more  or  less  perfect,  which  had  been  broken 
down;  it  is  nearly  one  and  a half  lines  in  thickness,  and,  for 
the  most  part,  projects  about  as  much,  but  towards  the  vulva 
increases  rather  suddenly  to  one  inch  in  width.  From  a 
patient  of  Dr.  David  Osgood,  who  died  of  phthisis.  Catamenia 


204 


FEMALE  ORGANS  OF  GENERATION. 


generally  scanty.  Married  six  years,  but  for  the  last  two  had 
not  lived  with  her  husband ; had  miscarried  twice  at  about  the 
third  month,  and  had  borne  one  child,  which  lived  nine  months. 
The  husband  had  formerly  mentioned  the  great  difficulty  which 
he  had  in  coitu.  1836. 

652.  Malformation  and  imperfect  development  of  the  internal  geni- 
tal organs  in  an  adult  female.  The  subject  of  this  case  was  a 
respectable  German  emigrant,  twenty-five  years  of  age ; admit- 
ted to  the  Alms-house,  under  the  care  of  Dr.  Ezra  Palmer, 
February  13th,  1838,  and  on  the  15th  of  March  was  discharged. 
On  the  first  of  April  she  was  re-admitted  with  oedema  of  the 
face  and  limbs,  headache,  &c.,  and  on  the  16th  of  the  same 
month  suddenly  died ; reported  the  catamenia  as  having  been 
absent  for  five  months,  and  Dr.  P.  regarded  it  as  a common 
case  of  amenorrhcea.  Dr.  P.  subsequently  found  a friend  of 
the  patient,  and  apparently  a credible  person,  to  whom  the  girl 
had  made  the  following  statements  in  regard  to  her  case : that 
she  was  the  daughter  of  a respectable  farmer,  and  arrived  in 
this  country  in  September,  1837  ; that  before  she  embarked 
her  health  had  been  perfectly  good,  and  her  menstruation  reg- 
ular ; that  after  suffering  much  from  sea-sickness,  and  being 
wrecked,  the  catamenia  stopped,  and,  on  her  arrival,  she  had 
swelling  of  the  limbs,  spitting  of  blood,  headache,  &c.,  which 
symptoms  were  very  naturally  attributed  to  the  amenorrhcea. 

On  examination  after  death,  the  external  organs  of  genera- 
tion were  as  perfectly  well  formed  as  in  any  adult  female ; but, 
on  separating  the  labia,  the  vagina,  or  rather  the  vulva,  was 
found  to  be  about  half  an  inch  in  extent,  and  to  terminate  in  a 
cul  de  sac,  the  inner  surface  having,  however,  the  usual  ap- 
pearance. 

The  pelvic  organs  being  removed,  the  rectum  was  carefully 
dissected  from  the  bladder,  and  the  vagina  was  then  found  to 
be  completely  wanting.  In  the  situation  of  it  the  cellular 
membrane,  to  the  extent  of  seven  or  eight  lines  laterally,  was  a 
little  thicker  than  it  was  on  each  side,  but  without  any  trace  of 
a cavity. 

The  uterus  consisted  of  two  distinct  cornua,  of  a regular, 
elongated,  cylindrical  form,  extending  transversely  across  the 
pelvis,  and  intimately  connected  with  the  fundus  of  the  bladder. 


FEMALE  ORGANS  OF  GENERATION. 


205 


Something  like  the  rudiment  of  a body  of  the  organ,  was  sent 
off  by  these  to  be  lost  insensibly  in  the  cellular  membrane 
which  represented  the  vagina ; it  was  about  an  inch  and  a half 
in  extent,  slightly  thickened,  fleshy  to  the  feel,  but  without  any 
cavity. 

Left  cornu  three  inches  in  length ; three  lines  in  diameter  at 
first,  but  increased  to  five  at  the  free  extremity,  which  was 
rather  blunt.  It  consisted  of  a coarse,  loose,  fibrous  structure, 
of  a reddish  color,  and  having  somewhat  of  a muscular  ap- 
pearance, but  without  any  trace  of  a cavity.  Fallopian  tube 
three  inches  and  three-fourths  in  length,  and  of  about  the 
usual  size ; fimbriated  extremity  large  and  free.  Ovary  about 
one-third  as  large  again  as  usual,  of  a flattened  form,  smooth 
on  the  surface,  and  very  flaccid  to  the  feel,  as  if  it  contained 
many  vesicles,  though  it  was  not  cut  open ; hung  free  in  the 
cavity  of  the  pelvis  in  a sort  of  broad  ligament,  but  much  less 
to  the  left  side  than  usual ; ligament  connecting  it  with  the 
cornu  quite  distinct. 

Right  cornu  six  inches  and  a half  in  length,  or  more  than 
twice  that  of  the  other,  for  the  most  part  about  three  lines  in 
diameter,  but  increasing  to  six  at  its  ovarian  extremity.  It 
differed  from  the  other  cornu  in  structure,  being  white,  rather 
dense,  and  more  resembling  the  common  “ uterine  tissue ; ” no 
trace  of  cavity.  After  it  left  the  fundus  of  the  bladder,  it  pen- 
etrated through  the  muscles,  and  appeared  at  the  external 
inguinal  ring;  there  it  gave  off  a Fallopian  tube,  three  inches 
in  length,  of  about  the  usual  size,  and  having  a free  and  well 
developed  fimbriated  extremity.  The  ovary,  which  laid  fairly 
in  the  groin  between  Poupart’s  ligament  and  the  fascia  super- 
ficialis,  was  one  inch  and  a third  in  length,  two-thirds  of  an 
inch  in  width,  and  one-third  of  an  inch  in  thickness,  of  a very 
regular,  oval  form,  a little  flattened,  rather  firm,  very  white, 
and  much  more  resembling  a testicle  than  an  ovary ; it  was 
nearly  surrounded  by  serous  membrane,  forming  a sort  of 
tunica  vaginalis,  though  between  the  opposing  surfaces  there 
were  numerous  adhesions;  the  Fallopian  tube  was  mostly,  if 
not  entirely  bound  dowm  by  adhesions,  besides  being  very  much 
contorted,  so  that  the  limits  between  it  and  the  cornu  were  not 
readily  made  out. 

The  kidneys  wTere  much  and  very  peculiarly  diseased,  but 


206 


FEMALE  ORGANS  OF  GENERATION. 


did  not  exactly  resemble  any  of  the  forms  described  by  Dr. 
Bright.  The  bladder,  which  was  large  and  collapsed,  con- 
tained three  or  four  ounces  of  urine,  some  of  which,  being 
tested  by  heat,  coagulated  strongly. 

In  the  preparation  the  uterus  and  its  appendages  are  shown, 
the  thickened  cellular  tissue  in  place  of  the  vagina,  the  ex- 
ternal organs,  and  the  urinary  bladder. 

653.  Inversion  of  the  uterus.  From  a patient  of  Dr.  George  C. 
Shattuck ; forty-three  years  of  age,  had  been  married  seven 
years,  and  had  had  several  miscarriages,  but  had  never  carried  a 
child  to  the  full  period.  For  the  last  three  or  four  years  had 
suffered  as  much  during  menstruation  as  from  labor.  Three 
months  before  death  there  came  on  profuse  flooding,  which 
continued  at  intervals  until  the  last  six  weeks,  when  it  nearly 
ceased,  and  she  had  constant  discharges  of  pus  from  the  vagina. 
Had  much  pain  and  distress  in  pelvis,  especially  on  motion  or 
even  in  the  upright  position,  and  also  with  dejections ; nausea 
and  often  vomiting  when  pain  was  severe ; bowels  costive ; no 
dysuria ; examination  per  vaginam  always  refused. 

On  dissection,  about  a quart  of  pus  was  removed  from  the 
cavity  of  the  pelvis,  after  which  the  inverted  uterus  appeared, 
looking,  as  it  still  does  in  the  preparation,  not  unlike  an  enlarged 
os  tincse,  with  some  old  peritoneal  adhesions  about  it,  the  Fallo- 
pian tubes  being  mostly  drawn  in,  but  not  the  ovaries.  Within 
the  vagina  the  uterus  formed  a smooth,  soft,  livid,  pyriform 
tumor  about  the  size  of  a large  orange ; the  inversion  is  nearly 
complete,  and  the  remains  of  the  os  tincae  are  seen  about  the 
neck  of  the  tumor.  1837. 

654.  Polypus  uteri.  The  patient  was  fifty  years  of  age,  and  had 
formerly  had  several  children,  but  was  afterwards  divorced 
from  her  husband,  and  led  a very  dissolute  life.  During  the 
last  year  occasional  flooding,  though  not  profuse  ; three  or  four 
weeks  before  death,  however,  it  increased  so  as  to  cause  pros- 
tration, and  was  soon  followed  by  great  pain  and  tenderness  in 
the  abdomen  ; for  this  she  was  vomited  and  purged  actively  by 
an  empiric,  and  died  under  the  operation  of  the  medicines, 
universal  and  acute  peritonitis  being  found  on  dissection.  The 
uterus  was  enlarged,  measuring  four  inches  and  a half  in 


FEMALE  ORGANS  OF  GENERATION. 


207 


length,  two  and  a half  in  width,  and  nearly  one  inch  at  the 
thickest  part ; muscular  structure  not  developed  as  in  the  case 
of  fibrous  tumors.  The  polypus  grows  from  the  fundus,  and 
was  just  long  enough  to  protrude  through  the  os  tincse,  having 
a long  peduncle,  but  enlarging  at  the  extremity  to  one  inch  in 
diameter.  This  last  part,  which  was  probably  the  source  of 
the  hsemorrhage,  was  quite  soft,  of  a dark  red  color,  and,  being 
deeply  torn,  showed  a coarse,  loose,  stringy  rather  than  fibrous 
tissue  ; the  peduncle  was  firmer  and  not  discolored,  and  the 
surface  was  every  where  smooth  except  where  torn.  1839. 

Another  case  of  polypus  will  be  hereafter  reported,  in  con- 
nection with  a case  of  ruptured  uterus. 

655.  Uterine  polypus,  of  a regular,  pedunculated  form,  one  inch 
and  a half  in  length,  somewhat  fissured  upon  the  surface,  and 
of  a dense,  white  structure.  Removed  by  an  operation.  The 
patient  had  at  the  time  an  infant  fourteen  months  old,  and  had 
been  subject  for  five  years  to  what  she  regarded  as  prolapsus 
uteri.  Did  well  during  her  pregnancy  and  confinement,  and 
continued  pretty  well  until  the  spring  of  1841,  when  she 
flowed  almost  constantly ; from  this,  however,  she  was  at  last 
relieved.  Had  also  about  the  same  time  severe  bearing-down 
pains,  and,  as  she  thought,  a protrusion  of  the  os  uteri  exter- 
nally ; an  examination  was  then  made  by  Dr.  John  Ware,  her 
attending  physician,  and  the  polypus  was  discovered.  In 
August  it  was  removed  by  Dr.  George  Hayward,  with  the 
scissors.  Very  little  blood  was  lost  during  the  operation,  but, 
five  or  six  hours  afterwards,  on  the  patient’s  rising  from  her 
bed,  profuse  haemorrhage  took  place ; this,  however,  was  soon 
checked,  and  she  has  had  no  further  trouble  since.  Dec.  1842. 

656.  Prolapsus  uteri.  The  pelvic  organs  have  been  removed  entire, 
and  the  preparation  shows  a complete  prolapsus,  the  appear- 
ances, both  externally  and  within  the  pelvis,  being  most  accu- 
rately represented  in  Cruveilhier’s  figure  of  a similar  case 
(Liv.  xvi.  pi.  5) ; the  uterus  could  very  easily  be  pushed  back, 
and  then  had  the  same  constricted  appearance  which  is  shown 
in  one  of  the  figures.  The  patient,  an  octogenarian,  died  of 
meningeal  apoplexy,  under  the  care  of  Dr.  William  P.  Dexter, 
and  the  date  of  the  prolapsus  is  unknown.  1844. 


208 


FEMALE  ORGANS  OF  GENERATION. 


657.  Fibrous  tumors  of  the  uterus.  They  are  so  developed 
throughout  its  substance  that  the  whole  mass  appears  of  a 
rounded  form,  and  nearly  as  large  as  a child’s  head.  The 
cavity  of  the  uterus  is  much  elongated,  and  the  muscular  and 
vascular  structure  are  developed  as  in  gestation ; the  enlarge- 
ment of  the  blood-vessels  is  particularly  well  shown,  as  the 
specimen  was  taken  from  a dissecting-room  subject  which  had 
been  injected. 

658.  Several  fibrous  tumors,  more  or  less  pedunculated,  and  hang- 
ing, as  it  were,  from  the  peritoneal  surface;  the  largest,  about 
the  size  of  an  orange,  has  been  cut  open,  and  is  a very  fine 
specimen  of  the  fibro-cellular  structure.  The  uterus  itself  is 
very  little  enlarged. 

659.  Portion  of  a large  fibrous  tumor  of  the  uterus,  in  a state  of 
inflammation  or  disorganization,  from  a woman  who  died  after 
an  abortion  at  the  seventh  month  of  gestation.  The  patient 
was  twenty-eight  years  of  age,  and  had  been  married  for  two 
years.  Was  first  seen  by  her  physician,  Dr.  M.  S.  Perry, 
November  14th,  1838.  Reported  then  as  follows:  — Health 
always  good,  except  for  dysmenorrhoea,  until  seven  months 
since,  when  she  became  pregnant  with  her  first  child.  From 
that  time  until  August  she  had  much  vomiting,  with  pain  in  the 
right  side  of  the  abdomen;  then  an  attack  of  dysentery,  which 
lasted  for  two  or  three  weeks,  followed  by  increased  pain  in  the 
side,  with  tenderness  on  pressure,  indigestion,  diarrhoea  most 
of  the  time,  nervous  symptoms,  and  prostration  of  strength 
which  confined  her  to  the  room.  When  seen  on  the  14th,  she 
was  uncommonly  large  for  the  seventh  month ; tenderness  ex- 
treme on  right  side  ; countenance  bad;  pulse  quick  and  feeble, 
and  skin  dry ; diarrhoea  continued,  and,  on  walking,  she  suf- 
fered from  bearing  down,  and  from  dyspnoea.  The  pain  was 
relieved  by  external  applications,  but  the  other  symptoms  con- 
tinued the  same,  and  on  the  26th  of  the  same  month  she  abor- 
ted. After  the  placenta  came  away,  a circumscribed  tumor 
was  found  in  the  right  side  of  the  abdomen,  extending  from 
the  crest  of  the  ilium  to  the  ribs,  and  forwards  as  far  as  the 
umbilicus.  For  the  first  two  days  she  was  very  comfortable; 
on  the  third  there  was  some  appearance  of  milk,  but  the  lochia 


FEMALE  ORGANS  OF  GENERATION. 


209 


diminished  and  there  was  considerable  heat  of  the  skin ; on  the 
fourth  day  diarrhoea,  with  some  tenderness  of  the  abdomen 
and  meteorism,  and  in  the  night  delirium.  From  this  time  she 
gradually  sank,  and  died  on  the  eleventh  day,  with  symptoms, 
as  it  was  supposed,  of  peritonitis. 

On  dissection,  the  peritoneum  was  found  healthy,  but  the 
inner  surface  of  the  uterus  was  inflamed,  as  shown  by  redness, 
and  an  extensive  deposit  of  recent,  opaque,  whitish  lymph. 
The  tumor  arose  from  the  right  side  of  the  fundus  by  a small 
pedicle  of  uterine  tissue,  was  situated  in  front  of  the  ascending 
colon,  and  connected  posteriorly  with  the  neighboring  parts  by 
old  adhesions;  it  was  about  six  inches  in  diameter,  and  une- 
qually firm,  feeling  boggy  in  some  parts,  and  in  some  encysted. 
On  incision,  it  was  found  to  consist  mainly  of  the  usual  fibro- 
cellular  structure,  but  much  broken  down,  and  containing 
throughout  its  substance  numerous,  very  irregular  cavities,  in 
which  was  a thin  serous  fluid  such  as  is  often  discharged  from 
a scrofulous  abscess,  the  parietes  being  whitish,  opaque,  soft, 
and  of  a veiy  loose  texture.  The  cavities  were  not  large,  and 
some  of  them  appeared,  to  use  a comparison  of  Cruveilhier’s, 
like  little  geodes  in  the  midst  of  the  sound  structure.  Immedi- 
ately in  the  neighborhood  of  one  of  the  largest  cavities  the 
fibrous  structure  was  infiltrated  to  a considerable  extent  with 
an  opaque,  yellowish  lymph,  as  if  preparatory  to  breaking 
down,  but  there  was  nowhere  in  the  tumor  any  redness,  nor 
any  well  formed  pus. 

This  change  in  the  fibrous  tumor  is  figured  by  Cruveilhier. 
(Liv.  xxiii.  pi.  6.)  As  the  result  of  pregnancy,  however,  it 
has  been  particularly  described  by  Dr.  Ashwell  (Guy’s  Hospi- 
tal Reports,  No.  II.) ; he  thinks  that  it  takes  place  during  the 
latter  months,  and  that,  being  highly  dangerous  to  life,  prema- 
ture labor  should  be  induced,  but,  in  the  above  case,  the  disease 
was  already  quite  advanced  at  the  seventh  month,  and  had 
probably  been  going  on  for  some  time,  and  in  Dr.  A.’s  first 
case,  in  which,  judging  from  his  figure,  the  disease  must  have 
been  still  more  extensive,  the  patient  was  only  advancing 
towards  the  sixth  month ; the  change  may,  perhaps,  then,  begin 
in  the  early  months  of  gestation.  It  may  be  remarked  that 
the  above  case  differs  from  those  observed  by  Dr.  A.,  inasmuch 
as  he  found  the  uterus  healthy  or  very  nearly  so,  and  he 
27 


210 


FEMALE  ORGANS  OF  GENERATION. 


remarks  that  it  has  been  found  so  in  the  majority  of  cases. 

660.  A single,  rounded  tumor,  four  inches  and  a half  in  diameter, 
and  developed  entirely  in  the  posterior  parietes  of  the  uterus. 
The  structure  was  very  peculiar,  being  neither  fibrous  nor  cel- 
lular, hut  rather  resembling  in  appearance  and  consistence  the 
fibrinous  deposit  from  the  blood,  the  whole  being  rather  moist, 
and  of  a dull,  pale  red  color,  as  if  stained  by  blood.  One 
regular  cavity  is  seen,  about  two-thirds  of  an  inch  in  diameter, 
quite  smooth  inside,  and  partly  filled,  when  recent,  with  a thick, 
pasty,  reddish  substance ; cut  surface  generally  rough,  with 
many  small  holes  and  fissures,  and  in  one  place  the  tumor  had 
the  thin,  white,  parchment-like  envelope,  which  is  sometimes 
met  with  in  these  cases.  This  was  regarded  as  a fibrous  tumor 
in  a state  of  degeneration.  The  uterus  and  tumor,  together, 
in  this  case,  weighed  three  pounds,  and  formed  a regular, 
rounded  mass,  which  seemed  to  fluctuate  before  being  opened. 
The  cavity  of  the  uterus  is  enlarged,  and  contained  a bloody 
mucus,  and  the  muscular  and  vascular  structures  are  seen  to 
be  very  strongly  developed ; cervix  not  involved.  Ovaries 
small,  and  adhere  to  the  tumor. 

From  a patient  of  Dr.  John  Jeffries ; an  unmarried  lady, 
aged  forty-four  years,  and  who  died  of  acute  dysentery. 
Tumor  had  existed  for  at  least  five  or  six  years,  the  abdomen 
being  quite  prominent;  never  interfered  with  the  pelvic  organs, 
the  menstruation  being  regular,  although  the  general  health 
had  rather  declined.  1840. 

661.  Ossification  of  several  fibrous  tumors;  they  hang  off  from  the 
peritoneal  surface,  and  one  of  them,  which  is  about  the  size  of 
a hen’s  egg,  has  been  sawed  open.  The  organ  itself  is  almost 
buried  by  them,  but  seems  otherwise  not  much  affected.  From 
a woman,  seventy  years  of  age. 

662.  Ossified  tumors  dissected  out  from  the  uterus,  and  dried.  One 
of  them,  which  is  about  an  inch  in  diameter,  hung  from  the 
fundus,  and  was  covered  only  by  the  peritoneum ; the  other, 
about  half  as  large,  was  imbedded  in  the  substance  of  the 


organ. 


FEMALE  ORGANS  OF  GENERATION. 


211 


663.  Corroding  ulcer  of  the  uterus.  The  os  tincse,  cervix,  and  a 
great  part  of  the  body  of  the  organ  are  entirely  destroyed,  and 
the  ulceration  has  proceeded  far  down  the  vagina,  but  the  sur- 
rounding parts  are  neither  indurated  nor  thickened;  ulceration 
well  defined,  but  not  deep.  The  disease  is  complicated  with 
several  simple,  fibrous  tumors,  which  are  seen  attached  to  the 
fundus  of  the  uterus,  one  of  which  is  cut  open  to  show  its 
structure,  and  being  nearly  as  large  as  the  fist,  had  formed  a 
tumor  which  was  felt  for  some  months  before  death.  The 
other  organs  of  the  abdomen  and  thorax  were  healthy.  From 
a patient  of  Dr.  D.  H.  Storer;  she  was  a married  woman, 
forty-nine  years  of  age,  but  had  not  lived  with  her  husband  for 
some  time,  having  once  received  the  venereal  disease  from 
him ; never  had  children.  The  uterine  symptoms  had  existed 
for  more  than  a year ; pain  very  severe ; discharge  from  vagina, 
which,  towards  the  last,  was  excessively  foetid,  but  never  any 
haemorrhage;  became  sallow,  very  much  emaciated,  and  died 
worn  out  by  her  extreme  sufferings.  1835. 

664.  Greater  part  of  the  uterus  destroyed  by  cancerous  disease. 
The  patient  was  about  sixty  years  of  age,  had  had  symp- 
toms of  pelvic  disease  for  about  eight  years,  and  for  the  last  six 
months  incontinence  of  urine. 

665.  Extensive,  old  adhesions  about  the  appendages  of  the  uterus, 
obliteration  of  the  extremities  of  the  tubes,  and  an  encysted  state 
of  the  left  ovary ; from  a woman  who  had  been  a prostitute  for 
two  years  and  a half  or  more.  The  uterus  appears  healthy. 
1838. 

666.  Dropsy  of  the  Fallopian  tube.  The  serum  having  been  forced 
out,  the  tube  has  been  distended  and  dried.  1840. 

667.  Cholesterine  from  the  Fallopian  tube.  From  a patient  of  Dr. 
Charles  E.  Ware  ; died  in  February,  1846,  of  encephaloid 
disease  of  the  stomach,  the  other  organs  being  sufficiently  well, 
except  for  two  biliary  calculi  in  the  gall-bladder.  The  extrem- 
ity of  the  right  Fallopian  tube  was  dilated  into  a cavity  about 
the  size  of  a filbert,  and  was  filled  with  the  cholesterine,  which 
appeared  in  the  form  of  yellowish  white,  dryish,  closely  packed 


212 


FEMALE  ORGANS  OF  GENERATION. 


scales,  having  a beautiful  pearly  lustre,  easily  rubbed  down, 
and  shown  to  be  greasy  when  heated  upon  paper  before  the 
fire ; this  was  a shut  cavity,  and  was  lined  by  mucous  mem- 
brane. The  rest  of  the  tube,  having  been  cut  open,  was  found 
to  be  coated  with  a thin  layer  of  the  same  deposit,  so  as  to 
resemble  the  inside  of  an  oyster  shell ; this  was  very  readily 
rubbed  off,  and  then  the  mucous  membrane  presented  its  usual 
appearance.  On  examination  under  the  microscope,  by  Dr.  John 
Bacon,  Jr.,  the  deposit  presented  the  appearance  of  rhomboidal 
scales,  and  exhibited  colors  with  the  polarizing  attachment ; a 
portion  of  it  was  afterwards  prepared  by  Dr.  M.  Gay,  and 
resulted  in  a delicate  white  substance,  which,  being  again  ex- 
amined by  Dr.  B.,  gave  very  perfect  crystals,  and  much  more 
brilliant  colors  than  the  crude  mass.  A quantity  of  the  pre- 
pared cholesterine  is  preserved  in  a phial,  and  some  upon  a 
watch-glass. 

Since  the  occurrence  of  this  case  cholesterine  has  been 
shown  to  the  Society,  taken,  in  one  instance,  from  the  fluid  of 
a hydrocele,  and  in  another,  from  the  substance  of  the  kidney. 

668.  Fallopian  tube  distended  by  tuberculous  matter.  The  inner 
surface  of  the  uterus  was  similarly  diseased.  From  a case  of 
phthisis.  May,  1844. 

ii.  Vagina  and  External  Organs. 

669.  The  opening  from  the  vagina  into  the  vulva  traversed  by  a 
firm,  fleshy  band,  so  as  to  be  equally  divided  upon  the  median 
line;  from  a new  born  child,  and  otherwise  well  formed. 

Dr.  Charles  G.  Putnam. 

670.  The  bowls  of  two  large  tea-spoons,  with  a small  portion  of  the 
handle,  a broad,  gold  finger-ring,  and  two  pieces  of  crockery 
ware.  Removed  by  Dr.  S.,  with  a pair  of  dressing  forceps, 
from  the  vagina  of  a patient  at  the  Lunatic  Asylum,  South 
Boston ; they  had  probably  been  there  for  about  four  months, 
and  had  caused  great  irritation.  February,  1844. 

Dr.  Charles  H.  Stedman. 


671.  Several  pieces  of  thick,  white,  dense,  fibrous  membrane,  four 


FEMALE  ORGANS  OF  GENERATION. 


213 


or  five  inches  in  length,  and  which  were  reported  by  a patient, 
who  had  suffered  from  dysmenorrhosa,  to  have  been  dis- 
charged from  the  vagina.  In  the  same  jar  there  have  been 
placed  some  strips  of  ligamentum  nuchse,  and  it  is  evident 
that  they  are  the  same  substance.  The  patient  was  quite  a 
respectable  woman,  and  the  physician,  who  brought  the  speci- 
mens to  the  city,  for  a consultation  upon  the  case,  seemed  to 
be  a man  of  intelligence,  but  would  not  listen  to  the  idea  of 
imposture ; about  a year  afterwards  he  was  again  in  the  city, 
and  was  as  firm  in  his  belief  as  before,  the  membrane,  as  he 
said,  being  still  occasionally  discharged. 

672.  A large,  warty  tumor,  removed  from  the  labia.  Weighed  one 
pound  and  a quarter,  when  recent,  is  imperfectly  lobulated, 
generally  quite  dark  on  the  surface,  but  in  one  or  two  places 
has  a smooth,  white  cicatrized  appearance ; consistence  fleshy, 
and,  in  structure,  appears  as  if  it  might  be  allied  to  elephanti- 
asis. One  very  distinct  lobe,  which  is  about  the  size  of  a fig, 
arose  from  one  of  the  internal  labia,  and  almost  the  whole  of 
the  remaining  mass  was  a growth  from  the  one  upon  the  other 
side.  It  was  removed  by  Dr.  William  J.  Walker,  with  a por- 
tion of  the  clitoris,  but  the  disease  returned  not  long  afterwards ; 
haemorrhage  moderate  during  the  operation.  The  patient  was 
an  unmarried,  respectable  female,  thirty -three  years  of  age, 
and  was  under  the  care  of  Dr.  George  Bartlett ; the  disease 
had  been  forming  for  about  fifteen  years,  and  troubled  her  only 
by  bulk  and  weight  of  the  mass.  1839. 

673.  A second  specimen,  similar  to  the  last ; removed  by  an  opera- 

tion. The  tumor  is  nearly  as  large  as  the  two  fists,  and  very 
firm  to  the  feel;  warty  appearance  strongly  marked,  deeply 
lobulated,  and  surface  dark,  with  one  smooth,  whitish  cicatrix  as 
in  the  other  specimen.  The  patient  was  a black  girl,  of  bad 
habits.  Dr.  S.  D.  Townsend. 

674.  A tumor,  which  was  removed  by  ligature  from  one  of  the 
labia;  attached  by  a small  pedicle,  but  resembled  pretty  nearly 
the  last  two  specimens.  It  was  nearly  three  inches  in  length, 
of  a flattened,  oval  form,  dark  colored,  wrinkled  rather  than 
warty  upon  the  surface,  quite  flaccid  to  the  feel,  and,  being  cut 


214 


FEMALE  ORGANS  OF  GENERATION. 


through  on  one  side,  appeared  to  consist  of  a simple,  lax,  cel- 
lular tissue.  The  patient  was  a married  lady,  thirty-seven 
years  of  age ; the  tumor  had  been  forming  for  about  two  years, 
and  appeared  at  first  as  a small  wart ; caused  no  trouble  ex- 
cept from  its  weight,  being  six  inches  in  length  before  removal, 
and  filling  with  fluid  when  she  was  in  the  erect  position.  1842. 

Dr.  John  Homans. 

675.  Foul  ulceration  of  the  whole  inner  surface  of  the  vagina,  but 

without  any  appearance  of  malignant  deposit.  An  opening 
into  the  rectum  is  seen,  nearly  two  inches  in  length,  and 
another  was  about  forming  into  the  bladder.  The  uterus  was 
rather  small,  with  corroding  ulceration  of  the  os  tincae,  and 
acute  inflammation  of  the  inner  surface ; this  organ  and  the 
vagina  are  shown,  cut  open.  From  an  Alms-house  patient; 
she  was  sixty  years  of  age,  had  been  long  subject  to  uterine 
haemorrhage,  and  for  the  last  five  years  to  discharge  from  the 
vagina,  which  was  sometimes  foetid  and  sanious ; towards  the 
last  her  sufferings  were  very  great,  and  for  some  weeks  before 
death  a free  communication  existed  between  the  rectum  and 
bladder.  The  case  had  been  regarded  as  one  of  cancer  of  the 
womb.  1834.  Dr.  J.  W.  McKean. 

hi.  Ovaries. 

676.  Cretaceous  deposit  upon  the  surface  of  the  ovary.  It  appears 

in  the  form  of  an  opaque,  white  crust,  with  some  small  grains, 
and  is  scattered  over  the  surface  to  which  they  adhere.  From 
a middle-aged  woman,  who  had  been  married  for  several  years, 
but  had  never  been  pregnant,  there  being  some  old  adhesions 
about  the  ovaries,  with  an  obliteration  of  the  extremity  of  one 
of  the  Fallopian  tubes;  the  peritoneum,  otherwise,  was  healthy. 
In  the  preparation,  the  great  mass  of  the  ovary  has  been  dis- 
sected away,  and  the  portion  of  the  surface  upon  which  the 
deposit  is  formed,  has  been  spread  upon  a black  board  and 
dried.  This  specimen  having  been  very  fully  examined  by 
Dr.  John  Bacon,  Jr.,  it  appears  that  the  deposit  consists  of  the 
phosphate  of  lime,  with  animal  matter,  there  being  no  trace  of 
the  triple  phosphate ; under  the  microscope,  it  has  a waxy 
lustre,  and  the  surface  is  mamillated,  but  there  is  no  crystalline 
appearance.  1847.  Dr.  J.  B.  S.  Jackson. 


FEMALE  ORGANS  OF  GENERATION. 


215 


677.  Encysted  disease  of  the  ovary.  The  tumor  is  about  half  as 

large  again  as  a man’s  head.  Cysts  distended  and  dried,  with 
the  uterus  attached.  Dr.  S.  D.  Townsend. 

678.  Encysted  ovary ; about  the  size  of  a hen’s  egg.  Hair  is  seen, 
which  was  contained  in  the  cysts,  and  mixed,  as  usual,  with 
fatty  matter.  The  patient  died  of  phthisis. 

Dr.  J.  W.  McKean. 

679.  Encysted  disease  of  the  ovary,  with  a considerable  quantity 
of  hair  attached  to  the  interior,  as  represented  by  Cruveilhier 
(Liv.  xviii.)  The  mass  was  large  enough  to  fill  the  cavity  of  the 
pelvis,  and  was  formed  mainly  by  a single  cyst,  which  was 
filled  with  clear  serum.  The  hair  was  contained  in  a separate 
cyst,  with  fatty  matter,  and  the  surface  from  which  it  grew 
consisted  apparently  of  well  formed  cutis  and  cuticle,  the  pores 
being  as  distinct  as  upon  any  part  of  the  scalp ; some  of  the 
hairs  were  free,  and  without  any  appearance  of  a bulb.  There 
are  also  two  small  pieces  of  bone  in  the  parietes  of  the  cyst. 
A dry  specimen. 

From  a patient  of  Dr.  J.  M.  Whittemore,  of  Brighton;  a 
lady,  twenty-one  years  of  age,  who  died  of  inflammation  of 
the  articulations  of  the  pelvis,  with  phlebitis,  after  her  first 
confinement,  having  previously  enjoyed  full  health.  1837. 

680.  Hair  from  an  ovarian  cyst;  mostly  free  in  the  fatty  matter, 
but  some  was  found  growing  from  the  interior  of  the  cyst. 
From  a dissecting-room  subject. 

681.  Another  specimen,  a small  portion  of  the  dried  cyst  having 
been  preserved,  with  some  of  the  hair  attached.  The  patient, 
an  unmarried  woman,  thirty-five  years  of  age,  had  an  ovarian 
tumor  of  immense  size,  which  had  been  forming  for  about 
seventeen  years.  The  contents  of  the  cysts  were  various,  and 
in  one  of  them,  which  was  about  the  size  of  an  orange,  was 
found  the  hair.  1838. 

682.  Diseased  ovary,  from  a cancerous  subject.  It  is  of  a regular, 
flattened,  oval  form,  six  and  a half  inches  in  length,  and,  on 
incision,  after  having  been  in  spirit  for  several  years,  appears 


216 


FEMALE  ORGANS  OF  GENERATION. 


to  consist  of  an  uniform,  whitish,  condensed,  cellular  tissue, 
with  scarcely  any  fibrous  structure.  The  uterus  is  seen 
attached,  and  is  healthy.  As  there  was  cancer  of  the  bones  in 
this  case  (Nos.  97  and  219),  and  of  the  breast  (No.  685),  it 
was  thought  that  the  disease  of  the  ovary  might  be  of  the 
same  nature,  but  this  is  doubtful.  Dr.  S.  D.  Townsend. 

683.  Diseased  ovary,  from  a patient  of  Dr.  Charles  G.  Putnam ; a 
little  girl,  six  years  of  age,  who  died  of  very  extensive  malig- 
nant disease  of  the  abdomen.  (No.  509.)  Both  of  the  organs 
were  greatly  enlarged,  of  a regular,  oval  form,  very  soft,  and 
of  rather  a bright  red  color  externally.  That  on  the  right  side 
formed  a tumor  which  was  felt  three  months  before  death,  and 
measured  five  and  a half  inches  in  length  ; on  incision,  it  was 
found  to  consist  of  a coarse,  cellular  tissue,  abundantly  infil- 
trated with  serum,  and  containing  some  whitish,  carcinomatous 
deposit.  The  left  ovary,  which  is  the  one  preserved,  measured 
three  inches  and  a half  in  length,  and  resembled  the  other  in 
structure,  except  that  it  contained  much  effused  coagulated 
blood.  The  Fallopian  tube  is  seen  to  be  thickened,  and  much 
elongated  by  the  growth  of  the  ovary,  as  the  neck  of  the 
womb  sometimes  is  in  case  of  disease  or  displacement  of  that 
organ.  1840. 

684.  Both  of  the  ovaries  preserved  in  connection  with  the  uterus. 
They  are  about  the  size  of  a large  orange,  of  a rounded  form, 
irregular  or  knobbed  on  the  surface,  and  solid  to  the  feel.  One 
of  them  having  been  cut  open,  was  found  to  consist  of  very 
fine  cells,  filled  with  a clear,  yellow  serum,  but  without  any 
appearance  of  distinct  cysts,  and  without  carcinomatous  deposit 
or  effused  blood.  The  uterus  is  healthy.  The  patient  was  an 
unmarried  female,  forty-one  years  of  age,  and  died  at  the  Mass. 
Gen.  Hospital,  of  scirrhous  stomach  (No.  483),  with  ascites, 
and  a granulated  disease  of  the  peritoneum.  April,  1832. 

iv.  Breast. 

685.  Cancer  of  the  breast.  The  bones  were  extensively  diseased, 
and  one  of  the  ovaries.  (No.  682.)  Dr.  S.  D.  Townsend. 


(217) 


XI.  MALE  ORGANS  OF  GENERATION, 
i.  Testicle. 

686.  Absence  of  the  testicle.  The  vas  deferens,  which  has  been 
preserved,  is  of  the  usual  size  and  pervious,  and  terminates 
rather  bluntly  in  a sort  of  convolution,  in  the  inguinal  canal ; 
artery  and  veins  of  full  size.  There  was  no  appearance  of  a 
cicatrix,  and  Dr.  C.  could  not  learn  from  the  family  that  the 
testicle  had  ever  been  removed.  Upon  the  opposite  side  there 
was  a hydrocele,  with  slight  enlargement  of  the  organ.  From 
a patient  of  Dr.  Henry  G.  Clark ; a man,  fifty-five  years  of 
age,  who  died  from  poisoning  by  arsenic.  1841. 

687.  A loose  body  from  the  cavity  of  the  tunica  vaginalis ; it  con- 
sists of  a hard,  ossific  mass,  covered  by  a thin  layer  of  carti- 
lage, and  is  about  the  size  of  a pea.  From  a dissecting-room 
subject.  The  testicle  and  serous  membrane  were  healthy, 
except  that  from  the  last  there  hung  off  a slender  mass  of  half 
organized  lymph  about  a quarter  of  an  inch  in  length. 

Dr.  Henry  J.  Bigelow. 

688.  Several  fragments  of  ossific  matter,  from  the  testicle  of  an 

old  negro,  the  organ  being  about  three  times  its  usual  size. 
1834.  Dr.  Francis  W.  Cragin , of  Surinam. 

689.  Ossific  deposit,  about  an  inch  in  length,  in  the  substance  of  the 
testicle;  organ  otherwise  healthy,  although  there  is  seen  to 
have  been  an  universal  old  adhesion  of  the  tunica  vaginalis. 
From  a patient  of  Dr.  A.  A.  Gould;  an  old  syphilitic  case; 
from  the  same  subject  as  No.  96.  The  testicle  has  been  cut 
open. 

690.  Scrofulous  disease  of  the  testicle ; the  organ  is  about  twice  its 

usual  size,  and  is  converted  into  a solid,  yellowish,  curdy  sub- 
stance. Cord  healthy.  Dr.  S.  D.  Townsend. 

691.  A second  specimen;  not  cut  open.  Dr.  S.  D.  Toicnsevd. 

28 


218 


MALE  ORGANS  OF  GENERATION. 


692.  Fungous  disease  of  the  testicle.  The  organ  is  considerably 
enlarged,  and  presents  through  the  scrotum  an  extensive, 
raised,  foul,  shreddy,  ulcerated  surface.  It  was  removed  at 
the  Alms-house,  and  the  patient  did  well. 

• Dr.  Winslow  Lewis. 

# 

693.  Cancerous  disease  of  the  testicle ; removed  by  Dr.  Charles  T. 
Jackson,  from  a patient  of  Dr.  A.  A.  Gould.  The  organ  was 
about  the  size  of  a large  orange,  and  consisted  mainly  of  a 
substance  like  half-organized  lymph;  the  upper  portion  was 
semitransparent  and  indurated,  but  posteriorly  it  was  soft,  and 
highly  vascular.  Cord  quite  healthy.  The  patient  was  a 
laboring  man,  twenty-five  years  of  age,  and  had  had  pain  and 
swelling  of  the  organ  for  six  months,  caused  by  an  injury 
which  he  received  when  lifting  a barrel  of  apples.  Died  about 
a year  after  the  operation  from  a return  of  the  disease. 

694.  Disease  of  the  testicle.  The  specimen  was  brought  to  the 
Society  with  the  following  history,  by  Dr.  Benjamin  Cushing,  a 
nephew  of  Dr.  Thaxter,  in  whose  practice  the  case  occurred. 
The  patient,  a stout,  healthy  child,  was  first  seen  by  Dr.  T.  in 
September,  1843 ; the  left  testicle  was  then  about  the  size  of  a 
hen’s  egg,  and  there  was  considerable  external  redness,  the 
disease  having  been  discovered  about  a fortnight  before. 
Leeches  and  a saturnine  lotion  were  used  without  effect,  the 
tumor  increased  in  size,  and  in  November  the  patient  was 
carried  to  the  Mass.  Gen.  Hospital  for  further  advice ; an  ex- 
ploring needle  was  passed  in,  but  blood  only  was  discharged ; 
the  question  then  was  whether  the  case  was  one  of  haemato- 
cele  or  malignant  disease,  and  it  was  proposed  to  make  an 
incision,  but  to  this  the  child’s  mother  would  not  consent. 
From  this  time  until  the  following  September  the  patient  was 
under  the  care  of  different  practitioners,  but  was  often  visited 
by  Dr.  C. ; the  tumor  gradually  increased  in  size,  until  it 
measured  about  seven  inches  in  length,  and  five  inches  from 
before  backwards,  pressing  up  firmly  against  the  abdomen,  and 
so  far  involving  the  penis  that  the  situation  of  this  organ  was 
only  indicated  by  a fold  in  the  skin.  About  the  first  of  Sep- 
tember Dr.  T.  was  again  called ; the  surface  of  the  tumor  had 
recently  given  way,  and  the  integument  was  destroyed  to  the 


MALE  ORGANS  OF  GENERATION. 


219 


extent  of  about  three  inches ; haemorrhage  had  already  once  or 
twice  occurred,  and  the  blood  was  issuing  in  a jet,  the  tumor, 
meanwhile,  having  considerably  diminished  in  size.  From  this 
time  the  bleeding  frequently  recurred,  and  the  child  died,  ex- 
hausted, about  the  last  of  September,  1844,  aged  five  years 
and  eleven  months.  Had  no  pain  in  the  testicle,  nor  was  his 
general  health  affected  until  towards  the  last,  when  he  became 
much  emaciated. 

The  testicle  is  of  a regular,  oval  form,  and  about  as  large  as 
the  double  fist.  Being  cut  through,  the  body  of  the  organ 
measures,  after  having  been  in  spirit,  four  and  a half  by  two 
inches ; the  color  is  whitish,  the  consistence  fleshy,  and  the 
structure  close  and  compact,  the  appearance  throughout  being 
perfectly  uniform,  except  for  two  or  three  cavities,  half  an  inch 
or  more  in  diameter,  these  last  being  perfectly  defined,  smooth 
and  polished  upon  the  inner  surface,  and,  when  recent,  filled 
with  clear  serum.  The  epididymis  is  proportionably  enlarged, 
of  a purplish  color  when  recent,  and  now  darker  than  the 
body  of  the  organ,  the  limits  between  the  two  being  well 
marked.  In  no  part  of  the  mass  is  there  to  be  seen  any  trace 
of  the  original  structure,  nor  any  appearance  of  malignant 
disease ; the  ulcerated  surface  is  covered  with  a blackish 
crust,  the  remains  probably  of  the  blood  which  was  discharged 
during  life.  The  cord  is  healthy,  as  was  the  other  testicle,  and, 
so  far  as  seen,  the  organs  of  the  abdomen. 

Dr.  Robert  Thaxter , of  Dorchester. 

695.  Encephaloid  disease  of  the  testicle,  removed  by  an  operation. 

The  patient  was  a healthy-looking  infant,  seventeen  months 
old,  and  the  disease  was  first  observed  at  the  age  of  six  months. 
The  organ  is  about  as  large  as  that  of  an  adult,  and  the  body 
of  the  gland  is  completely  disorganized,  presenting  as  perfect 
a specimen  of  the  disease  as  would  ever  be  seen  in  an  older 
subject.  October,  1846.  Dr.  Winslow  Leiois. 

ii.  Prostate  Gland. 

696.  Lateral  lobes  of  the  prostate  gland  much  enlarged,  and,  as  is 
often  the  case,  the  left  more  than  the  right ; no  appearance  of 
a middle  lobe.  Bladder  sacculated.  The  patient,  a healthy- 


220 


MALE  ORGANS  OF  GENERATION. 


looking  farmer,  over  seventy  years  of  age,  died  of  disease  of 
the  heart,  having  had  dysuria  for  some  years,  though  not 
severely. 

697.  Lateral  lobes  of  the  prostate  enlarged,  but  much  less  so  than 
in  the  last  specimen;  middle  lobe  also  enlarged.  Bladder 
sacculated. 

698.  Enlargement  of  the  lateral  and  third  lobes  of  the  prostate 
gland;  bladder  thickened  and  sacculated.  The  patient  was 
about  sixty-five  years  of  age,  and  had  suffered  much  from  the 
disease  for  several  years.  1841.  Dr.  George  C.  Shattuck. 

699.  Portion  of  a prostate  gland,  showing  calculi  in  situ,  many 
others  having  been  removed.  (No.  700.)  From  a patient  of 
Dr.  George  C.  Shattuck,  a gentleman,  sixty-five  years  of  age, 
who  had  been  long  subject  to  dysuria,  and  died  at  last  from 
disease  of  the  heart.  The  ducts  of  the  gland  are  much  en- 
larged, and  crowded  with  calculi,  the  substance,  also,  seeming 
to  be  filled  with  fine  particles  of  the  same.  1838. 

700.  A collection  of  prostatic  calculi  from  the  above  case.  (No.  699.) 
They  are  well  characterized,  and,  having  been  analyzed  by 
Dr.  Charles  T.  Jackson,  were  found  to  contain  64  per  cent,  of 
the  phosphate  of  lime,  8 per  cent,  of  the  carbonate  of  lime, 
and  28  per  cent,  of  xanthic  oxide,  five  grains  being  the  amount 
that  was  used.  Treated  with  nitric  acid  and  warmed,  a fine 
lemon-colored  solution  was  rapidly  effected,  with  a disengage- 
ment of  gas,  and,  when  the  solution  was  saturated  with  liquid 
ammonia,  a fine  orpiment  yellow  precipitate  was  formed, 
which  was  the  xanthic  oxide  mixed  with  phosphate  of  lime. 
1838. 

iii.  Penis. 

701.  Penis  injected  and  the  bladder  distended  and  dried. 

702.  Corpora  cavernosa  inflated,  dried,  and  cut  open. 

703.  Penis  of  a negro,  showing  an  entire  absence  of  the  frsenum,  as 


UTERO-GESTATJON. 


321 


seen  in  the  Chimpanse,  and  without  any  appearance  of  its 
having  been  destroyed  by  disease.  1842. 

Dr.  Samuel  Parkman. 

704.  Hypospadias,  the  urethra  terminating  beneath  the  glans  penis ; 
from  an  adult. 

705.  Venereal  warts.  The  prepuce  is  much  enlarged,  and  its 
inner  surface  nearly  covered  with  the  excrescences,  the  glans 
itself  being  healthy.  The  patient,  a young  negro,  entered  the 
Marine  Hospital  at  Chelsea,  in  consequence  of  a severe  hsemor- 
rhage  from  the  diseased  surface ; there  was  complete  phymosis, 
with  several  fistulous  openings  through  the  prepuce.  The 
patient  would  not  consent  to  the  usual  operation,  but  insisted 
upon  amputation  of  the  organ,  which  was  at  last  performed. 

Dr.  Charles  H.  Stedman. 

706.  A very  highly  finished  pencil  drawing  of  the  appearances  in 
the  last  case  before  the  operation  ; by 

Dr.  J.  Francis  Tuckerman. 

707.  “ Penis  and  scrotum  of  a subject  who  was  syphilitic  for  many 
years  before  death,  but  had  recovered  with  the  loss  of  a great 
portion  of  the  penis ; a bougie  is  in  the  urethra.” 

Dr.  S.  D.  Townsend. 

708.  Cancer  of  the  prepuce,  the  glans  being  apparently  healthy ; 

amputation  was  performed,  but  the  disease  afterwards  returned, 
and  proved  fatal.  Dr.  Abel  L.  Peirson , of  Salem. 


XII.  UTERO- GESTATION. 

i.  Parts  belonging  to  the  Mother. 

709.  Uterus  at  a very  early  period  of  impregnation ; from  a patient 
of  the  late  Dr.  Charles  T.  Hildreth.  Twenty-seven  days 
before  her  death,  the  subject  of  this  case  passed  the  evening 


222 


UTERO- GESTATION. 


with  a man,  from  whom  she  had  been  receiving  attentions, 
and  it  was  ascertained  that  they  had  not  been  alone  together 
for  a considerable  time  before  nor  after  that  date.  Had  not 
menstruated  for  six  weeks,  and  on  this  account,  according  to 
her  statement,  she  took  half  an  ounce  of  the  oil  of  tansy ; 
violent  spasms  ensued,  and  she  died  in  rather  less  than  two 
hours.  A full  account  of  the  case  and  of  the  symptoms  which 
were  produced  by  the  poison,  were  published  in  the  Boston 
Medical  Magazine  for  November,  1834. 

The  uterus  was  carefully  examined  twelve  hours  after  death, 
and  the  following  appearances  were  noted : — Length  of  the 
organ  four  inches.  Fundus  and  body  doughy  to  the  feel,  the 
first  being  of  a dark  red  color.  Os  tincse  quite  prominent, 
thick,  and  fleshy,  and  upon  the  inner  surface  red,  as  from 
mechanical  irritation.  A crucial  incision  having  been  made 
through  the  anterior  face,  the  cavity  of  the  organ  was  fully 
exposed,  the  parietes  being  not  much  thicker  than  in  the  unim- 
pregnated state.  The  inner  surface  of  the  body  and  fundus, 
to  the  depth  of  two  or  three  lines,  had  a somewhat  fibrous 
appearance,  but  was  exceedingly  soft,  and  almost  pulpy ; the 
line  of  demarcation  between  this  and  the  firmer  substance 
beneath  being  sufficiently  defined,  although  the  two  could  not 
be  separated  like  two  distinct  textures ; towards  the  fundus  this 
surface  was  of  a reddish  color,  but  generally  it  was  whitish, 
though  not  opaque.  Near  the  centre  of  the  fundus  there  was 
a rounded  cyst,  of  a dark  reddish  color,  and  about  half  an  inch 
in  diameter.  On  cutting  this  open,  an  ovum  soon  made  its 
escape,  seeming  to  have  little  or  no  connection  with  its  interior. 
Within  the  chorion  the  amnion  was  seen  as  a very  delicate  cyst, 
and  about  the  size  of  a robin-shot,  and  still  within  this  there 
were  distinctly  seen  the  rudiments  of  the  embryo.  The  cyst 
which  contained  the  ovum  was  closely  connected  with  the  inner 
surface  of  the  uterus,  although  quite  different  from  it  in  texture, 
being  thin,  moderately  firm,  and  upon  its  inner  surface  smooth 
and  polished,  though  rather  irregular.  Cervix  not  much 
changed,  and  its  cavity  not  closed,  except  by  viscid  mucus  ; 
the  openings  into  the  Fallopian  tubes  appeared  also  to  be  free. 
The  left  ovary  contained  a corpus  luteum,  about  the  size  of  a 
marble,  the  yellow  portion  being  more  than  a line  in  thickness, 
and  the  cavity  being  filled  with  coagulated  blood.  In  the 


UTER0-GESTAT10N. 


223 


preparation,  the  ovum  is  seen  floating  at  the  bottom  of  the  jar, 
and  the  structure  of  the  cyst  at  the  fundus  of  the  uterus,  and 
of  the  softened  inner  surface  of  the  fundus  and  body  is  satis- 
factorily shown. 

The  softened  inner  surface  of  the  uterus  above  described 
was  undoubtedly  the  decidua  vera,  and  the  case  is  interesting 
inasmuch  as  the  view  which  was  taken  of  it  at  the  time  was  in 
accordance  with  what  has  since  become  an  established  fact  in 
science.  The  decidua  has  generally  been  considered  as  an 
adventitious  membrane  thrown  out  upon  the  inner  surface  of 
the  organ,  and  of  which  the  organization  is,  to  say  the  least, 
very  questionable ; and  it  was  only  in  the  year  1834,  the  very 
year  when  the  above  case  occurred,  that  Weber  promulgated 
what  is  probably  the  true  doctrine  in  regard  to  this  subject,  as 
appears  in  Muller’s  Physiology.  When  the  above  case  was 
published,  the  question  was  asked,  in  regard  to  the  softened 
tissue,  “ was  this  the  decidua  ? or  is  it  the  internal  surface  of 
the  womb  in  a softened  state  ? ” We  did  not  dare  to  express 
our  conviction  that  it  was  the  latter,  as  it  was  so  opposed  to  the 
doctrines  of  the  day,  but,  in  the  notes  of  the  case,  which 
were  taken  at  the  time,  after  a description  of  the  tissue  in 
question,  it  is  distinctly  stated  that  there  is  “ no  appearance  of 
anything  like  decidua.” 

710.  Uterus  of  a woman  who  died  about  the  third  month  of  preg- 

nancy, from  excessive  vomiting.  The  organ  is  partially  laid 
open  by  a crucial  incision,  and  shows  the  two  portions  of  the 
decidua  and  the  chorion ; the  corpus  luteum  is  also  seen  in  the 
left  ovary.  From  a patient  of  Dr.  John  Ware. 

711.  Tubular  pregnancy.  The  uterus  measured  three  inches  and 
one-fourth  in  length,  and  was  changed  in  structure  as  usual  in 
gestation;  inner  surface  softened,  but  without  any  well  marked 
decidua.  The  outer  half  of  the  right  Fallopian  tube  was 
enlarged  to  about  the  size  of  the  last  joint  of  the  thumb,  and, 
having  been  cut  open,  the  membranes  of  the  ovum  are  shown, 
with  a well  developed  foetus,  three-fourths  of  an  inch  in 
length. 

The  lady  from  whom  this  specimen  was  taken,  was  a patient 
of  Dr.  John  D.  Fisher ; eighteen  years  of  age,  and  had  been 


224 


UTERO-GESTATION. 


married  only  ten  weeks.  The  catamenia  appeared  on  the  day 
of  her  marriage ; at  the  end  of  three  weeks  it  appeared  again, 
as  she  thought,  and  in  two  weeks  more  it  appeared  for  the  third 
time ; discharge  unusually  profuse,  of  a bright  red  color,  and 
continued  for  a week  without  much  intermission.  After  the 
last  period  it  frequently  recurred,  and,  on  any  considerable 
exertion,  became  so  profuse  as  to  cause  faintness.  On  the 
morning  of  the  last  day  she  was  unusually  cheerful,  and  had 
been  exercising  freely,  so  as  to  become  somewhat  fatigued. 
At  11  o’clock,  A.  M.  profuse  flooding  came  on,  and  she  be- 
came excessively  faint ; at  one  o’clock  Dr.  F.  found  her  with 
symptoms  of  complete  collapse,  as  from  haemorrhage ; under 
the  use  of  stimulants  she  revived  somewhat,  but  remained  in  a 
fluctuating  state  until  nine  in  the  evening,  when  re-action 
became  pretty  fully  established ; soon  after  this  she  fell  asleep, 
and  slept  until  about  half  past  three,  when  she  awoke  quite 
faint,  and  so  continued  until  seven  in  the  morning,  when  she 
died,  twenty  hours  from  the  time  of  the  attack.  There  had 
been  slight  pain  with  tenderness  just  above  the  right  groin,  a 
sense  of  fulness  in  the  abdomen,  and  an  unusual  degree  of 
fulness  over  the  lower  part,  on  examination  by  the  hand. 

On  dissection,  there  were  found  three  quarts  or  more  of 
blood  in  the  peritoneal  cavity,  the  right  Fallopian  tube  having 
ruptured  at  the  point  which  is  marked  in  the  preparation  by  a 
reddish  brown  coagulum. 

In  several  other  cases  of  tubular  pregnancy  which  have 
occurred  in  this  city,  there  has  been  observed  a tendency  to 
haemorrhage,  as  in  the  above  case,  though  not  to  the  same 
degree,  the  patient  generally  regarding  the  discharge  as  an 
irregular  flow  of  the  catamenia,  and  as  an  evidence  that  preg- 
nancy did  not  exist. 

712.  Oviduct  of  a domestic  fowl,  distended  near  its  upper  extrem- 
ity by  the  materials  of  several  eggs,  which  had  been  arrested 
in  their  progress  downwards,  and  form  a rounded  tumor  as 
large  as  the  fist,  and  consisting  of  a solid,  opaque,  albuminous- 
looking  substance.  The  organ  itself  has  been  preserved 
throughout  its  entire  length,  and  appears  healthy.  One  or  two 
other  specimens  have  been  shown  to  the  Society,  and  a similar 
one  is  described  in  the  Catalogue  of  the  Hunterian  Museum, 
(Part  I.  970.)  Dr.  J.  B.  S.  Jackson. 


UTERO-GESTATION. 


225 


713.  A transverse  section  of  the  ovary  of  a Striped  Basse  (Lahrax 
lineatus ),  distended  by  ova,  which  have  been  formed  upon  the 
inner  surface  during  successive  years,  three  or  four  distinct, 
concentric  layers  being  now  seen.  The  section  measures  about 
three  inches  in  diameter,  the  whole  mass  is  quite  solid,  and  the 
enveloping  cyst,  or  ovary,  seems  not  to  be  thickened. 

Dr.  D.  H.  Storer. 

714.  Extra-uterine  foetation;  fcetus  removed  through  the  anterior 
parietes  of  the  abdomen  by  Dr.  Nathaniel  Miller,  of  Franklin, 
and  presented  by  him  to  the  Society,  May  10th,  1841,  with  the 
following  history  of  the  case : — The  patient  was  a married 
woman,  thirty-four  years  of  age.  Pregnancy  occurred  about 
seven  years  since,  but  nothing  remarkable  occurred  until  she 
arrived  at  the  full  period,  when  the  motions  of  the  child  became 
very  active,  and  continued  so  for  about  a month ; they  then 
ceased  altogether,  and  she  felt  a dead  weight,  becoming  also, 
as  she  said,  thinner  about  the  waist;  the  lochia  came  on,  and 
continued  for  about  a week,  and  for  a time  there  was  a flow  of 
milk.  From  that  time  she  kept  about  her  house,  her  health 
being  sufficiently  good ; was  perfectly  sensible  of  the  presence 
of  the  foetus,  and  imagined  that  she  could  feel  the  bones.  In 
about  six  months  she  again  became  pregnant,  and,  to  sum  up 
the  case  in  a few  words,  she  has  borne,  during  the  last  seven 
years,  three  living  children,  and  carried  them  to  the  full  period, 
having  had  one  previously.  In  December,  1840,  she  consulted 
Dr.  M.  with  regard  to  an  operation ; for  about  six  w’eeks  there 
had  been  considerable  pain  and  tenderness  in  the  abdomen, 
with  loss  of  appetite  and  flesh;  a very  hard  tumor  was  found 
about  the  middle  of  the  abdomen,  perhaps  rather  more  to  the 
right  side,  but  the  parts  of  the  foetus  could  not  be  felt.  Dr.  M. 
thought  the  expediency  of  an  operation  doubtful,  and  saw  her 
again  in  about  a fortnight,  when  she  had  altered  decidedly  for 
the  worse.  About  the  first  of  January  the  operation  was  per- 
formed. A small  incision  having  been  made  below  the  umbil- 
icus, the  tumor  was  punctured  with  a trocar,  and,  when  the 
opening  was  sufficiently  enlarged,  the  fcetus  appeared,  lying 
coiled  up  in  the  most  compact  form  ; the  upper  extremity  pre- 
sented, but  one  foot  was  seized,  and  by  this  it  was  extracted. 
Something  was  found  which  looked  like  a cord,  but  nothing 

29 


226 


UTERO-GESTATION. 


like  a placenta.  The  foetus  weighed  four  pounds  and  a half 
after  the  extraction,  and  appeared  fresh,  excepting  one  foot, 
which  was  somewhat  decomposed;  some  of  the  other  small 
bones  of  the  hands  and  feet,  and  some  of  the  cranial  bones 
are  seen  in  the  specimen  to  be  more  or  less  denuded,  but  this, 
Dr.  M.  thinks,  is  owing  to  decomposition  since  the  removal. 
On  the  day  after  the  operation,  Dr.  M.  found  some  traces  of 
fcecal  matter  about  the  wound,  and  these  continued  unequivo- 
cally to  be  seen  so  long  as  she  lived ; death  occurred  in  about 
a month,  and  it  was  supposed  that  a communication  had  formed 
before  the  operation  between  the  intestine  and  the  sac  which 
contained  the  foetus.  Body  not  examined. 

715.  Bones  of  an  extra-uterine  foetus,  removed  from  the  bladder, 
by  the  operation  of  lithotomy,  by  the  late  Dr.  Joseph  Bossuet, 
of  this  city,  the  following  history  of  the  case  having  been  pub- 
lished by  Dr.  B.  in  the  sixth  volume  of  the  New  England 
Journ.  of  Med.  and  Surg. : — 

In  the  month  of  October,  1807,  Mrs.  C.,  of  Braintree,  be- 
came pregnant,  and  from  that  time  suffered  very  great  distress, 
with  pains  shooting  from  the  hypogastric  to  the  epigastric 
regions,  until  the  latter  part  of  the  following  spring,  when  the 
signs  of  labor  came  on ; as  the  child  could  not  be  felt,  large 
doses  of  opium  were  given,  and  in  the  course  of  a fortnight 
the  pains  abated.  For  two  months  afterwards  she  was  much 
troubled  by  a disagreeable  “ drawing”  sensation,  and  the  abdo- 
men was  greatly  enlarged,  but  this,  after  some  time,  gradually 
subsided.  During  the  next  three  years  there  was  not  much 
distress,  but,  at  the  end  of  that  time,  she  began  to  have  very 
acute  pains,  with  profuse  evacuations  by  the  urethra,  of  a 
matter,  which  was  sometimes  yellow,  sometimes  bloody,  and 
veiy  fcetid,  some  very  small  bones  being  voided  at  the  same 
time.  A communication  also  took  place  between  the  rectum 
and  bladder,  so  that  the  urine  and  faeces  would  pass  either 
way. 

During  the  five  years  preceding  Dr.  B.’s  first  visit  to  her, 
the  patient  suffered  excruciating  pain,  day  and  night.  On  the 
20th  of  May,  1816,  he  was  called,  and,  having  ascertained  the 
nature  of  the  case,  advised  an  operation,  which,  on  the  17th  of 
June,  was  performed,  one  hundred  and  forty-six  bones  of  a 


UTERO-GESTATION. 


227 


seven  months  fcetus  being  removed,  together  with  a stone  about 
the  size  of  an  olive.  Dr.  B.’s  report  of  the  case  was  dated 
March  24th,  1817,  at  which  time  the  patient  had  fully  regained 
her  health,  and  was  quite  free  from  pain,  the  communication 
between  the  rectum  and  bladder,  however,  not  being  wholly 
obliterated. 

The  bones  were  given  to  Dr.  B.  by  the  patient  herself,  who 
is  now  (May,  1841)  living  in  a neighboring  town.  Since  the 
operation,  her  general  health  has  continued  to  be  sufficiently 
good,  so  that  she  has  attended  to  her  household  affairs,  although 
she  has  never  been  able  to  retain  her  urine.  The  bones  are 
displayed  upon  a black  board,  with  the  fragments  of  the  cal- 
culus. Dr.  Henry  I.  Bowditch. 

716.  An  extra-uterine  cyst,  filled  with  foetal  bones;  from  a Sheep. 

A dry  specimen.  1842.  Dr.  J.  V.  C.  Smith. 

717.  Uterus  of  a woman  who  died  three  days  after  labor  at  the  full 

period.  Dr.  Winslow  Lewis. 

718.  Polypus  of  the  womb;  laceration  of  the  organ  during  a diffi- 
cult labor ; malformation,  the  cavity  of  the  fundus  being  divided 
by  a septum.  The  specimen,  being  very  bulky,  has  been  pre- 
served in  an  open  jar. 

From  a patient  of  Dr.  George  Hayward ; a lady,  thirty-nine 
years  of  age ; had  had  for  at  least  two  or  three  years  what  she 
regarded  as  a prolapsus  of  the  womb,  but  which  was  undoubt- 
edly the  polypus,  although  she  had  in  the  meantime  borne  one 
if  not  two  children.  In  March,  1837,  labor  again  came  on, 
and,  when  Dr.  H.  saw  her,  towards  evening,  the  arm  was  found 
to  protrude ; the  child  was  turned  about  7 P.  M.,  and  the 
labor  soon  accomplished,  but  the  woman  sank  rapidly,  and  died 
in  about  two  hours,  without  any  external  haemorrhage,  although 
the  peritoneal  cavity  was  found,  on  dissection,  to  contain  a 
large  quantity  of  blood.  Before  the  delivery  a mass  was  felt 
in  the  vagina,  which  was  supposed  to  be  the  placenta. 

On  the  following  day  the  organs  were  removed.  The  poly- 
pus was  of  a flattened,  pyriform  shape,  and  arose  from  the 
posterior  parietes  of  the  cervix,  leaving  about  half  an  inch  of 
the  os  tincse  below  it.  Before  the  dissection,  it  protruded  six 


228 


UTERO-GESTATION. 


inches,  by  measurement,  from  the  external  organs ; after  the 
removal  of  the  parts,  the  form  being,  of  course,  very  much 
altered,  it  measured  six  inches  in  length,  four  inches  and  three- 
fourths  in  width  inferiorly,  and  two  inches  and  three-fourths  at 
the  neck ; thickness  varied  from  about  one-third  of  an  inch  to 
one  inch  and  three-fourths.  The  inner  surface  of  the  uterus 
was  continued  over  it  to  some  extent,  and,  where  this  was  torn, 
it  was  shown  that  the  polypus  consisted  of  a coarse,  fibrous 
structure,  in  the  form  of  irregular  bundles,  and  held  together 
by  a loose,  cellular  tissue;  numerous  blood-vessels,  which 
could  be  inflated  with  the  blow  pipe,  were  also  seen  in  the  sub- 
stance, and  upon  the  surface.  It  formed  altogether  a relaxed, 
fleshy  mass,  and,  although  described  as  fibrous,  showed  no 
appearances  of  having  originated  as  a common  fibrous  tumor; 
there  were,  however,  four  or  five  small  tumors  of  this  nature 
about  the  fundus  of  the  organ. 

The  laceration  was  two  inches  in  length,  oblique  in  its 
direction,  and  situated  at  the  posterior  part  of  the  cervix,  upon 
the  left  side ; parietes  of  the  organ  apparently  healthy,  except 
for  the  polypus. 

As  to  the  malformation,  it  did  not  appear  externally,  but, 
within,  the  cavity  of  the  fundus  was  found  to  be  divided  upon 
the  median  line  by  a septum,  which  extended  downwards  three 
inches,  the  entire  length  of  the  organ  being  about  eleven 
inches.  Cruveilhier  figures  a case  (Liv.  iv.  pi.  5,  fig.  5,)  in 
which  the  septum  extended  down  to  the  cervix,  but  without  any 
appearance  of  division  externally. 

719.  A very  correct,  and  highly  finished  colored  drawing  of  a rup- 
tured uterus.  The  patient  was  a healthy  Irish  woman,  twenty- 
seven  years  of  age,  and  died  in  labor  with  her  third  child, 
three  hours  after  the  rupture  was  supposed  to  have  occurred. 
The  uterus  itself  was  eleven  inches  and  a half  in  length ; the 
laceration  was  situated  in  the  posterior  parietes  of  the  organ, 
towards  the  left  side,  and  measured  seven  niches  and  a half ; 
peritoneum  stripped  up  extensively.  The  foetus  laid  almost 
entirely  in  the  peritoneal  cavity,  and  the  placenta  was  found 
near  the  stomach ; there  was  also  much  effused  blood  in  the 
cavity.  The  case  occurred  in  the  practice  of  Dr.  Henry  G. 
Clark,  and  the  drawing  was  made  for  him  by  Mr.  H.  Billings. 
1837. 


UTERO-GESTATION. 


229 


720.  A separation  by  sloughing  of  the  whole  inner  portion  of  the 
uterus.  The  case  occurred  in  the  practice  of  Dr.  James  M. 
Whittemore,  of  Brighton,  and  the  specimen  was  presented  to 
the  Society  by  Dr.  Walter  Channing,  who  gave  at  the  same 
time  a full  history  of  the  case. 

The  patient  was  twenty-five  years  of  age,  and  was  taken  in 
labor  with  her  first  child  on  the  26th  of  February,  1847.  On 
the  3d  of  March  Dr.  C.  saw  her  in  consultation.  The  pains 
had  continued,  and  she  had  got  but  little  sleep ; abdomen  ex- 
ceedingly hard,  and  very  large,  the  tumor  being  divided  by  a 
sulcus  upon  the  median  line.  With  great  difficulty,  from  her 
weight,  soreness,  and  inability  to  help  herself,  she  was  brought 
to  the  edge  of  the  bed,  and  laid  upon  her  left  side.  Upon 
examination,  it  appeared  that  the  foetus  was  still  within  the 
uterus,  and  in  a state  of  putrefaction,  being  extremely  flaccid, 
doubled  upon  itself,  presenting  by  the  left  side  of  the  trunk, 
and  having  in  the  left  side  of  the  chest  a large  opening,  through 
which  the  organs  of  the  thorax  and  abdomen  protruded ; the 
organs  appeared  as  a large  blackish  mass,  outside  of  the  ex- 
ternal organs,  and  had  been  down  since  4,  A.  M.  A constant 
discharge  of  most  offensive  flatus  was  passing  from  her  before 
she  was  moved,  but,  during  the  examination,  it  came  away  in 
volumes.  The  child  was  extracted  by  the  feet,  and  the  pla- 
centa was  removed  with  ease,  there  having  been  no  hsemor- 
rhage  at  any  time. 

Alarming  collapse  followed  the  delivery,  but  from  this  she 
soon  rallied,  under  the  use  of  stimulants,  and  was  doing  well 
until  the  11th  of  March,  when  she  began  to  complain  of  pain 
in  the  region  of  the  bladder,  and  two  or  three  days  afterwards 
something  was  found  to  protrude  from  the  vagina,  which,  in  a 
letter  to  Dr.  C.,  Dr.  Whittemore  described  as  “inflamed,  livid, 
and  very  offensive;”  on  the  17-th  it  came  away,  and,  having 
been  sent  to  Dr.  C.,  it  is  now  in  the  Society’s  Cabinet. 

On  examination  of  this  mass  it  is  seen  to  consist  of  a nearly 
perfect  sac,  its  general  form  resembling  that  of  an  uncontracted 
uterus  at  the  full  period  of  gestation,  and  its  length  being  about 
thirteen  inches.  It  is  generally  from  one  to  two  lines  in  thick- 
ness, dark  colored,  and  very  flaccid,  but  sufficiently  consistent 
to  allow  of  a full  examination,  and  showing  this  unequivocal 
evidence  of  its  being  a portion  of  the  uterus  itself,  that  upon 


230 


UTERO- GESTATION. 


one  of  its  surfaces  are  seen  the  extremities  of  vessels  of  con- 
siderable size.  These  vessels  have  all  the  appearance  of  ute- 
rine sinuses,  and  one  of  them  is  traceable  to  the  extent  of  two 
inches,  and  nearly  large  enough  to  admit  the  tip  of  the  little 
finger.  Upon  the  other  surface  are  several  patches  of  some 
size  of  a soft  substance,  which  may  have  been  effused  lymph. 
No  appearance  of  an  os  tincse. 

About  the  close  of  March,  or  beginning  of  April,  Dr.  C.  saw 
this  patient  again,  and  made  another  examination,  but  from  the 
extreme  soreness  of  the  organs,  the  prostration,  and  the  unwil- 
lingness of  the  patient  to  submit,  the  result  was  unsatisfactory. 
Posteriorly,  the  vagina  was  smooth,  and  natural  to  the  feel ; 
superiorly,  it  was  entirely  closed,  so  that  no  portion  of  the 
womb  could  be  reached  ; anteriorly,  a large  rough  surface  was 
felt,  from  which  the  urine  was  passing  in  streams,  and  about 
which  it  was  depositing  an  earthy  concretion.  The  parts  about 
the  superior  commissure,  and  the  urethra  seemed  to  be  in  a 
good  condition,  but  the  patient  would  not  allow  the  introduction 
of  a catheter  for  a full  examination  of  the  bladder. 

On  the  25th  of  June,  Dr.  Whittemore  reported  that  the 
patient  had  gradually  recovered  her  health,  and  had  been,  at 
that  period,  as  well  as  usual  for  several  weeks,  and  able  to 
attend  to  her  household  affairs.  The  soreness,  however,  con- 
tinued, and  the  discharge  of  urine  was  still  involuntary,  as  it 
had  been  from  the  first,  the  organs  being  much  excoriated. 

721.  Corpus  luteum,  from  a woman  who  died  after  an  abortion  at 
about  the  fourth  month.  It  is  seven  lines  in  diameter,  and  the 
yellow  portion  is  from  one  to  two  and  a half  lines  in  thickness. 
The  cavity  is  seen  to  be  lined  by  a firm,  smooth  cyst,  and  was 
filled,  when  recent,  with  clear  serum. 

Dr.  J.  B.  S.  Jackson. 

722.  Ossa  pubis,  showing  the  relaxation  which  takes  place  during 
gestation ; the  specimen  has  been  preserved  in  an  open  jar,  so 
that  it  may  be  removed  for  examination.  From  a woman, 
twenty-eight  years  of  age,  who  died  of  meningeal  apoplexy  at 
the  full  period  of  gestation,  and  before  labor  had  commenced. 
Had  previously  had  one  child,  and  for  about  a month  before 
her  confinement,  she  had  suffered  from  lameness  about  die 


UTERO-GESTATION. 


231 


pelvis,  which  increased  so  much  for  the  last  eight  or  ten  days, 
that  she  was  obliged  to  support  herself  on  going  up  stairs ; 
recovered  perfectly  after  her  confinement,  but  the  same  lame- 
ness was  again  felt  for  about  a month  before  her  death.  The 
bones  could  be  moved  so  freely  upon  each  other,  after  they 
had  been  sawed  out,  as  almost  to  overlap,  it  being,  however,  a 
simple  relaxation  of  the  connecting  fibro-cellular  tissue,  and 
without  any  redness,  cedema,  or  any  other  mark  of  disease. 
The  sacro-iliac  synchondroses,  also,  could  be  moved  very  per- 
ceptibly. 

A similar  relaxation  has  been  observed  in  several  other  cases 
which  have  occurred  here,  and  not  merely  towards  the  close 
of  pregnancy,  but,  to  a certain  degree,  in  the  earlier  months ; 
the  degree,  however,  varies  in  different  subjects  at  the  same 
period  of  gestation.  1839.  Dr.  J.  B.  S.  Jackson. 

723.  The  pelvis  of  a Guinea-pig,  showing  the  separation  of  the 
bones  that  takes  place  so  remarkably  in  this  animal  during 
gestation ; a dried  specimen.  The  ossa  pubis  are  far  apart, 
and,  when  recent,  the  sacro-iliac  articulations  were  much 
relaxed.  The  animal  died  of  acute  disease  some  time  before 
the  end  of  gestation.  May,  1846. 

Dr.  J.  B.  S.  Jackson. 

724.  A specimen  to  show  the  development  of  the  mammary  gland, 
which  takes  place  during  gestation ; it  very  nearly  resembles 
the  pancreas,  at  first  sight.  1847.  Dr.  J.  B.  S.  Jackson. 

ii.  Product  of  Conception. 

725-37.  Foetuses  with  the  membranes,  from  the  first  to  the  fifth 
month,  the  smallest  embryo  being  about  the  size  of  a pea. 
The  external  development  of  the  foetus,  in  these  specimens,  is 
well  shown,  and  many  points  in  the  anatomy  of  the  membranes, 
both  healthy  and  morbid.  An  attempt  has  been  made  to 
designate  the  age  of  each,  but  this  is  only  approximative,  the 
history  of  most  of  the  cases  being  unknown,  and  the  develop- 
ment in  several  of  them,  having  evidently  been  modified  or 
arrested  by  disease.  Most  of  the  specimens  have  been  cut 
open,  but  some  of  them  are  entire. 


232 


UTERO- GESTATION. 


One  only  (No.  729)  will  be  especially  described,  and  this 
more  particularly  with  reference  to  the  uterus,  which  was  also 
examined.  The  patient  was  an  unmarried  female,  who  took 
the  oil  of  Tansy  or  of  Hemlock  at  about  the  sixth  week  of 
pregnancy,  and  died  in  two  hours,  the  case  having  occurred  in 
the  practice  of  Dr.  Charles  E.  Ware.  The  uterus  was  four 
and  a half  inches  in  length,  and  contained  within  its  cavity 
about  half  a drachm  of  reddish  fluid.  The  decidua  vera  ex- 
tended as  far  as  the  cervix,  but  did  not  close  it ; the  blood- 
vessels and  porous  appearance  were  well  marked,  and  it  was 
evidently,  as  in  No.  709,  the  inner  surface  of  the  organ  itself, 
and  not  a new  formation,  the  decidua  reflexa  being  directly 
continuous,  though  very  different  in  structure.  The  ovum  was 
about  one  inch  and  a half  in  diameter,  and  was  detached 
without  difficulty,  leaving  a rough  surface,  and  showing  the 
existence  of  the  decidua  upon  the  corresponding  inner  surface 
of  the  uterus.  A large  space  existed  between  the  amnion  and 
chorion,  and  was  filled  with  a substance  which  resembled  the 
vitreous  humor  of  the  eye.  The  umbilical  vesicle  adhered  to 
the  external  surface  of  the  amnion,  near  the  root  of  the  cord, 
and  appeared  in  the  form  of  a very  delicate  cyst  about  the  size 
of  a pea  ; one  of  its  blood-vessels  was  quite  distinct ; the  duct, 
however,  was  not  to  be  seen,  but,  on  a second  examination,  the 
specimen  having  in  the  mean  time  been  in  spirit,  there  was 
some  appearance  of  a white  line  going  off  from  the  vesicle. 
The  foetus  was  about  half  an  inch  in  length,  and  developed 
externally  in  proportion.  The  cavity  of  the  corpus  luteum 
contained  about  half  a drachm  of  serum,  and  was  lined  with  a 
soft,  fiocculent,  infiltrated  tissue,  in  which  there  was  some 
effused  blood. 

In  the  preparation  the  umbilical  vesicle  is  shown,  with  the 
fcetus  and  membranes.  January,  1847. 

Since  the  above,  the  same  change  has  been  observed  in  the 
inner  surface  of  the  uterus  in  another  case,  the  blood-vessels 
being  in  some  places  of  considerable  size ; the  patient  died 
from  the  effects  of  long  continued  vomiting,  at  about  the  third 
month  of  pregnancy. 

738-43.  Foetuses  without  the  membranes,  from  about  the  age  of 
two  and  a half  to  six  and  a half  months. 


TJTERO-GESTATION. 


233 


744.  A fostus  affected  with  kirronosis,  as  described  and  figured  by 

Lobstein,  (Repertoire  general  d’Anat.  et  de  Physiol.  Yol.  I. 
1826.)  The  mother  had  borne  several  children,  and  this  was 
her  first  miscarriage.  She  supposed  herself  to  be  in  the  fourth 
or  fifth  month  of  pregnancy,  but  the  fetus  is  much  less  devel- 
oped than  it  should  be  at  that  period,  the  spine  measuring  only 
about  two  and  a half  inches  in  length.  About  a month  before 
the  abortion  the  abdomen  subsided,  the  breasts  became 
soft,  and  for  the  last  three  weeks  there  was  a yellowish 
discharge  from  the  vagina.  The  fetus  and  placenta  were 
expelled  together,  and  appeared  perfectly  exsanguine,  as  if 
they  had  been  macerated  in  spirit,  but  without  any  sign  of 
putrefaction.  The  placenta  and  membranes  were  not  other- 
wise remarkable,  but  the  cord  was  observed  at  once  to  have  a 
decided  tinge  of  kirronosis,  and  the  fetus  was  therefore 
removed  for  examination.  The  cavities  are  fully  exposed  in 
the  preparation,  and  the  inner  surface  of  the  anterior  abdomi- 
nal parietes  is  seen  to  be  of  a deep,  rich,  yellow  color ; the 
membranes  of  the  brain  seem  to  be  universally,  and  quite  as 
deeply  colored,  the  vault  of  the  cranium  having  been  removed 
upon  each  side  ; the  pleurae  and  pericardium  are  less  generally 
affected,  and  in  the  spinal  membranes  the  color  is  compara- 
tively faint.  There  is  nowhere  any  appearance  of  icterus. 
October,  1845.  Dr.  J.  B.  S.  Jackson. 

745.  The  posterior  portion  of  the  occipital  bone,  from  a case  of 
Cephalhaematoma,  which  occurred  in  the  practice  of  Dr.  S.  L. 
Abbott ; a dried  specimen.  The  mother  had  previously  had 
several  children,  and  one  of  them  was  affected  with  spina 
bifida.  In  the  present  case  the  labor  was  easy.  The  child 
was  a healthy  female,  and  the  tumor  was  observed  immediately 
after  birth ; it  was  then  quite  prominent,  rounded,  tense,  fluctu- 
ating, and  situated  over  the  occiput.  For  the  first  two  or  three 
days  the  whole  face,  scalp,  and  upper  extremities  were  of  a 
deep  red  color,  and  the  face  was  swollen  to  such  a degree  as 
to  close  the  eyes.  The  prominence  and  tension  of  the  tumor 
gradually  diminished  after  the  first  day,  and  at  the  time  of 
death  it  was  flattened,  diffused,  and  quite  soft ; the  hard  margi- 
nal ring  was  never  observed.  The  child  appeared  to  suffer  no 
inconvenience  from  this  affection,  but  it  soon  began  to  cough, 

30 


234 


UTERO- GESTATION. 


and  died  on  the  fourteenth  day,  with  the  symptoms  of  pneu- 
monia. 

On  dissection  the  scalp  was  found  healthy.  Pericranium 
slightly  ecchymosed  over  the  right  parietal  bone,  and  over  the 
upper  half  of  the  superior  portion  of  the  occiput  it  was  entirely 
detached,  the  cavity  thus  formed  between  it  and  the  bone  con- 
taining two  or  three  drachms  of  very  dark,  viscid  blood,  per- 
fectly inodorous,  without  a trace  of  coagulum,  and  evidently 
effused  some  time  before  death.  This  cavity  was  limited 
mainly  by  the  suture.  The  pericranium  was  extensively  ossi- 
fied toward  the  inferior  margin,  but  was  otherwise  not  remark- 
able. The  outer  surface  of  the  bone  was  completely  exposed, 
except  for  the  thinnest  pellicle  of  lymph,  and  was  perfectly 
healthy ; the  corresponding  inner  surface,  however,  to  the 
extent  of  nearly  one  inch,  was  elevated,  porous,  and  quite  vas- 
cular, the  limits  of  this  change  being  well  defined,  and  the 
vascularity  extending  somewhat  through  to  the  outer  surface ; 
there  was  no  appearance  of  caries,  and  the  bone  was  otherwise 
healthy.  The  dura  mater  wras  very  readily  detached  from  this 
vascular  portion  of  the  bone,  but  the  membrane  was  healthy 
and  no  effused  blood  was  found.  In  the  preparation  the  thick- 
ened, porous  appearance  of  the  bone  is  seen,  and  the  ossified 
condition  of  the  pericranium.  1847. 

746.  Placenta  injected. 

747.  Uterus,  showing  a portion  of  placenta,  about  an  inch  in  diam- 
eter, adhering  to  the  fundus ; the  organ  itself  is  about  five 
inches  in  length,  and  otherwise  not  remarkable.  From  a 
patient  of  Dr.  Anson  Hooker,  of  East  Cambridge ; a woman, 
forty  years  of  age,  of  delicate  health,  and  somewhat  subject  to 
fainting.  Labor  natural,  excepting  that  the  placenta  did  not 
come  away  for  an  hour  and  a half,  and  it  was  then  found  that 
a portion  had  been  retained.  After  her  confinement  she  did 
better  than  usual,  but  there  was  more  tenderness  and  enlarge- 
ment of  the  uterine  tumor,  and  towards  the  last  the  lochial  dis- 
charge was  rather  foul.  On  the  twelfth  day  after  her  confine- 
ment she  was  up  and  dressed,  and  expressed  herself  as  quite 
well,  but  on  the  following  morning,  she  rose  to  the  close-stool, 
swooned  several  times,  and  died  almost  at  once.  Nothing 


UTERO-GE  STATION. 


235 


found,  on  dissection,  to  explain  the  suddenness  of  the  death. 
1837. 

748.  Retention  of  the  placenta,  causing  an  extensive  destruction  of 
the  fundus  of  the  uterus  by  sloughing.  This  case  occurred  in 
December,  1842,  and  was  published,  with  remarks,  in  the  New 
England  Quarterly  Medical  Journal  (p.  570.)  The  patient 
was  twenty-one  years  of  age,  and  was  delivered  of  her  first 
child  on  the  7th  inst.,  at  5 o’clock,  A.  M.,  and  after  a labor  of 
a few  hours ; child  very  small.  The  uterus  contracted  well, 
but,  the  placenta  not  being  readily  detached,  an  examination 
was  made,  and  it  was  then  found  to  be  firmly  adherent  to  the 
fundus  of  the  organ.  After  waiting  for  several  hours,  an 
attempt  was  made  by  Dr.  S.  to  remove  it,  but  a small  portion 
only  was  brought  away,  and  in  the  evening  a similar  attempt 
was  made  by  another  practitioner,  and  with  the  same  result. 
For  the  first  three  days  there  was  nothing  alarming  in  the 
symptoms,  the  patient,  meanwhile,  having  taken  one  drachm 
of  ergot,  in  divided  doses,  and  a cathartic  of  castor  oil ; the 
lochia  appeared,  and  continued  to  flow,  the  milk  was  secreted, 
and  no  pain  nor  other  difficulty  was  complained  of. 

On  the  morning  of  the  fourth  day  the  pulse  had  risen  from 
84  to  140;  the  abdomen  was  tympanitic,  and  pressure  upon  it 
produced  considerable  uneasiness,  while  distinct  pain  was 
caused  in  the  uterus  by  the  application  of  external  force ; the 
lochia  and  milk  had  disappeared,  the  respiration  was  hurried, 
and  the  countenance  distressed,  it  being  evident  that  peritonitis 
had  supervened.  Dr.  Channing,  having  seen  the  patient  in 
consultation,  examined  the  uterus,  but  could  remove  nothing ; 
ten  leeches  were  then  applied  over  this  organ,  and  a poultice  to 
the  remainder  of  the  abdomen,  and  the  injections  of  the  chlo- 
ride of  soda,  which  had  previously  been  used,  were  continued. 
In  the  afternoon  she  seemed  relieved.  At  night  a Dover’s 
powder  was  given,  and  on  the  following  morning  she  was 
decidedly  better ; the  abdomen  was  less  affected  by  pressure, 
and  less  swollen,  the  pulse  had  fallen  to  100,  and  she  had  slept 
and  perspired  freely  during  the  night;  at  noon  she  was  still 
more  relieved,  but  in  the  afternoon  her  pain  gradually  returned, 
and  during  the  night  it  was  mitigated  only  by  opium.  On  the 
morning  of  the  sixth  day  she  was  found  in  the  greatest  distress ; 


236 


UTER0-GESTAT10N. 


pain  intense,  tympanitis  greatly  increased,  and  respiration 
labored.  During  the  whole  forenoon  the  pains  were  intermit- 
tent, as  in  labor,  and  increased  in  their  severity  until  they  could 
scarcely  be  borne,  but  in  the  afternoon  they  suddenly  ceased, 
and  did  not  again  return;  the  distention  of  the  abdomen 
increased,  the  respiration  became  more  labored,  the  pulse  rose 
to  160,  and  in  the  evening  she  died. 

Upon  examining  the  body  after  death,  the  fundus  of  the 
uterus  was  found  to  have  been  destroyed,  and  projecting 
through  it  into  the  abdominal  cavity,  was  seen  a large  portion  of 
the  placenta,  the  remainder  still  being  contained  within  the 
cavity  of  the  uterus ; the  body  and  neck  of  the  organ  were 
not  disorganized.  In  the  preparation  the  uterus  has  not  been 
cut  open,  and  the  placenta  is  seen  as  above  described. 

Dr.  D.  H.  Storer. 

749.  Extensive  ossific  deposit  over  the  uterine  surface  of  the  pla- 
centa ; from  a patient  of  the  late  Dr.  Charles  T.  Hildreth ; a 
dried  preparation.  A second  case  occurred  to  Dr.  H.  about 
the  same  time,  the  patient,  in  both  instances,  having  passed  her 
full  period,  as  she  supposed.  1838. 

750.  Tumor  in  the  placenta,  two  and  a half  inches  in  diameter,  well 

defined,  of  a regular  rounded  form,  situated  two  inches  from 
the  insertion  of  the  cord,  and  connected  with  the  outer  surface 
of  the  chorion,  being  in  fact  buried  in  the  substance  of  the 
placenta.  Appeared,  at  first,  white,  opaque,  and  elastic,  as  if 
encysted,  but,  on  being  cut  open,  it  is  found  to  be  uniform  in 
its  structure,  and  to  resemble  condensed  cellular  tissue ; some 
blood-vessels  in  it,  but  nowhere  any  appearance  of  effused 
blood.  The  placenta  was  otherwise  healthy,  and  the  labor 
natural.  1839.  Dr.  Henry  I.  Boicditch. 

751.  A blighted  ovum.  From  a patient  of  Dr.  J.  Mason  Warren; 
had  had  several  children,  and  was  not  subject  to  miscarriage. 
The  last  catamenial  period  occurred  in  July.  About  the  last  of 
November  she  had  some  discharge  of  blood,  but  the  abdomen 
continued  to  enlarge  for  two  or  three  weeks  afterwards,  when 
it  began  to  diminish  in  size,  and  on  the  5th  of  February  she 
called  on  Dr.  W.  to  know  whether  she  was  pregnant  or  not ; 
during  the  forenoon  she  was  abroad  for  some  time,  and  on  the 


UTERO-GESTATION. 


237 


following  night  had  flowing,  which  returned  on  the  14th,  when 
the  ovum  was  discharged  in  a perfectly  fresh  state.  It  was 
about  the  size  of  a goose  egg,  and  fleshy  to  the  feel,  the  ex- 
ternal surface  being  rough,  and  in  part  coarsely  granulated, 
much  of  it  seeming  to  consist  of  an  opaque,  white,  fibrinous 
substance,  the  inner  surface  of  the  cavity  having  the  usual 
botryoidal  appearance.  The  amnion,  chorion  and  decidua 
were  quite  distinct,  the  last  having  a dead,  yellowish  color ; 
cord  two  and  a half  inches  in  length,  small  and  much  twisted. 
The  fastus  was  sufficiently  plump,  but  exsanguine  in  appear- 
ance, and  measured  twenty  lines  from  the  vertex  to  the  coccyx  ; 
extremities  fixed  permanently  in  an  unnatural  position,  and 
terminated  in  a knobbed  appendage,  the  fingers  and  toes  not 
being  formed,  — most  of  the  above  appearances  are  shown  in 
the  preparation.  February,  1845. 

752.  A blighted  ovum,  retained  for  several  months,  from  a patient 
of  Dr.  John  Homans  ; had  previously  had  one  miscarriage,  and 
had  carried  one  child  to  the  full  period ; catamenia  quite  regu- 
lar. In  January,  1845,  she  menstruated  for  the  last  time,  and 
there  was  no  recurrence  until  after  the  first  of  the  following 
December,  on  which  day  the  ovum  was  discharged,  with  a 
moderate  amount  of  pain  and  flowing.  There  was  frequently, 
however,  a slight,  pale  bloody  discharge,  lasting  from  about 
one  to  twenty-four  hours,  and  in  March  there  was  a discharge 
which  lasted  for  three  or  four  days,  consisting  of  liquid  blood, 
with  at  first  a small  amount  of  coagulum  ; on  this  last  occasion 
Dr.  H.  was  sent  for,  but  both  he  and  the  patient  felt  confident 
that  no  miscarriage  had  taken  place.  No  bearing  down  during 
the  above  period.  Swelling  and  soreness  of  the  breasts  com- 
menced after  cessation  of  catamenia,  and  continued  throughout 
the  summer,  but  disappeared  before  the  ovum  was  discharged. 
There  was  also  swelling  with  hardness  of  the  abdomen, 
and  this  continued  until  the  termination  of  the  case,  although 
less  marked  for  the  last  few  weeks.  This  enlargement  was 
generally  about  as  much  as  it  usually  is  in  the  fourth  or  fifth 
month  of  pregnancy,  but  varied  much  at  different  times. 

When  first  discharged  the  ovum  had  a bloodless,  macerated 
look,  as  usual  in  cases  of  retention.  On  being  distended,  it  is 
seen  to  be  of  a spherical  form,  and  two  inches  in  diameter. 


238 


UTERO- GESTATION. 


The  placental  mass  is  perfectly  defined,  and  equal  in  extent  to 
about  one-half  of  the  whole  ovum  ; greatest  thickness  three 
lines.  The  membranes  were  thin,  but  sufficiently  firm,  the 
amnion  having  its  usual  polish,  and  being  readily  separated 
from  the  chorion.  No  trace  of  a foetus  or  cord.  In  the  pre- 
paration the  placenta  has  been  cut  through,  and  the  cavity  of 
the  ovum  is  partially  distended,  so  as  to  show  many  of  the 
points  above  noted,  but,  when  first  discharged,  the  membranes 
were  turned  in  so  as  to  be  in  close  contact  with  the  placenta, 
and  give  to  the  whole  mass  the  appearance  of  a cup-shaped 
cavity.  From  the  outside  of  the  chorion,  near  the  placenta, 
there  is  seen  hanging  a tattered  shred  of  decidua,  upon  which 
the  characteristic  porous  appearance  is  still  marked.  1845. 

753.  A large  mass  of  uterine  hydatids,  there  being  some  appear- 

ance of  membranes,  but  nothing  like  the  remains  of  a foetus. 
The  patient  was  fifty  years  of  age,  and  had  at  the  time  a 
healthy  living  child,  only  two  years  old  ; menstruated  regularly 
until  three  months  before  the  mass  was  expelled  ; flowing  for 
the  last  ten  days,  and  for  twenty-four  hours  to  a considerable 
amount,  and  with  much  pain.  Four  days  afterwards  there 
came  on  a severe  attack  of  puerperal  mania,  which  lasted  for 
three  or  four  weeks.  1834.  Dr.  J.  B.  S.  Jackson. 

754.  Uterine  hydatids.  The  patient  was  an  Irish  woman,  had  had 

nine  children,  and  supposed  herself  to  be  again  pregnant, 
although  some  of  the  symptoms  were  wanting ; the  catamenia 
had  ceased  for  three  and  a half  months,  but  there  had  been 
occasionally  slight  bleeding  from  the  uterus.  Signs  of  mis- 
carriage came  on,  and,  after  a dose  of  ergot,  about  half  a 
wash-basin  full  of  the  “ hydatids  ” were  discharged  ; they  were 
more  or  less  connected  by  membrane,  and  in  structure  and  va- 
riety of  size  and  form  corresponded  to  the  description  given 
by  Cruveilhier  (Liv.  1.  pi.  1,)  but  nothing  was  seen  like  the 
remains  of  a foetus.  1842.  Dr.  Henry  G.  Clark. 

755.  Umbilical  cord  about  forty-five  inches  in  length  ; passed  twice 
round  the  child’s  neck.  1839.  Dr.  Charles  G.  Putnam. 


756.  A knot  in  the  umbilical  cord.  1840.  Dr.  D.  H.  Storer. 


( 239  ) 


XIII.  MONSTROSITIES. 

i.  Monstrosities  by  Deficiency. 

757.  A lithographic  drawing  of  a specimen  which  was  presented 
to  the  Society  by  Dr.  George  C.  Shattuck.  This  form  of 
monstrosity  has  been  described  by  M.  Isod.  Geoff.  St.  Hilaire 
(Histoire  des  Anomalies,  vol.  II.  p.  469)  as  the  acephalus,  and 
the  external  appearances,  in  the  present  case,  are  well  repre- 
sented, and  perfectly  characteristic,  the  drawing  having  been 
made  directly  upon  stone. 

The  mother  of  this  subject  was  twenty  years  of  age,  and 
had  been  married  three  years.  On  the  25th  of  June,  1837, 
she  was  confined  for  the  second  time,  being  then  in  the  seventh 
or  eighth  month  of  pregnancy ; one  well  formed  child  had 
been  expelled,  when  the  monstrosity  presented  by  the  feet,  and 
was  withdrawn,  the  case  being  attended  by  Dr.  Ward  N. 
Boylston,  then  a pupil  of  Dr.  S. 

When  received,  it  was  quite  fresh,  weighed  nearly  four 
pounds,  and  measured  from  ten  to  eleven  inches  in  length. 
The  integuments  were  excessively  cedematous,  constituting  by 
far  the  great  bulk  of  the  fcetus,  and  on  the  back  and  sides 
were  found,  on  dissection,  several  large  cysts.  Superiorly,  it 
terminated  in  a regular,  rounded  mass,  and  upon  the  median 
line,  anteriorly,  and  not  far  from  the  above  termination,  there 
was  the  fleshy  protuberance  which  is  so  often  found  in  these 
cases.  This  protuberance,  which  represented  the  head,  con- 
sisted of  two  portions,  one  above  the  other,  and  closely  con- 
nected ; the  upper  one  was  of  a rounded  form,  and  four  or  five 
lines  in  diameter,  the  lower  one  being  considerably  smaller, 
and  terminating  anteriorly  in  two  points ; the  internal  structure 
of  this  mass  will  be  described  in  connection  with  the  skeleton. 
In  place  of  the  upper  extremities  there  appeared  externally, 
upon  the  right  side,  two  fingers,  which  looked  not  unlike  the 
claw  of  a lobster;  on  the  left  side  there  was  but  a single 
finger.  Both  of  the  feet  were  turned  in,  and  each  had  four 
toes,  those  on  the  right  side  being  equi-distant,  but  those  on  the 
left  irregular ; otherwise,  the  lower  extremities  were  well  de- 


240 


MONSTROSITIES. 


veloped.  The  anus  was  imperforate ; penis  well  developed  ; 
umbilical  cord  very  small,  and  much  shrivelled,  but  sufficiently 
long,  and  at  its  junction  with  the  abdomen  the  intestines  pro- 
truded, and  were  covered  only  by  a delicate  membrane. 

On  dissection,  there  were  found  in  the  abdomen  the  intes- 
tines, the  left  kidney,  two  renal  capsules,  the  bladder,  and  the 
testicles,  the  greater  part  of  the  intestines  being  contained  in 
the  hernial  sac.  The  stomach,  liver,  pancreas,  spleen,  and 
right  kidney  were  wanting. 

The  small  intestine  (No.  761)  was  eleven  inches  in  length, 
terminated  bluntly  in  a cul  de  sac,  and  was  nearly  filled  with 
a whitish,  curdy  substance.  The  large  intestine  was  eight 
inches  in  length,  and  contained  a white,  crumbling  substance 
at  its  upper  part ; the  rectum  was  filled  with  mucus,  and  ter- 
minated in  a cul  de  sac,  except  for  a very  minute  opening  into 
the  urethra,  just  in  front  of  the  verumontanum.  The  kidney 
rested  upon  the  front  of  the  spine,  or  a little  to  the  left  of  it, 
and  was  sufficiently  well  developed  ; renal  capsule  very  small, 
and  closely  attached  to  its  concave  edge.  On  the  right  side, 
the  renal  capsule  was  much  larger.  Bladder,  prostate  gland,  and 
testicles  well  developed.  Yas  deferens  wanting  upon  the  right 
side  ; upon  the  left,  it  was  traced  very  nearly  to  its  termina- 
tion in  the  urethra,  but  the  vesiculse  seminales  could  not  be 
found. 

The  heart  was  entirely  wanting.  In  the  American  Journ. 
of  Med.  Sciences  for  Feb.  1838,  in  which  this  case  was  pub- 
lished, there  is  a sketch  of  the  external  appearance  of  the 
foetus,  and  also  of  the  circulation,  the  course  of  which  was  as 
follows.  The  umbilical  vein  divided  into  two  large  branches 
soon  after  its  entrance  into  the  abdomen ; one  passed  down- 
wards to  supply  the  pelvis  and  lower  extremities ; the  other 
passed  upwards  on  the  right  of  the  spine,  and  divided  at  the 
upper  part  of  the  thorax,  to  form  the  right  and  left  subclavian 
and  jugular  veins ; about  the  middle  of  the  thorax  a large 
branch  was  sent  off  on  the  right  side,  and  which  seemed  to 
correspond  to  the  vena  azygos.  The  aorta  divided,  at  the 
upper  part  of  the  thorax,  into  the  right  and  left  subclavian 
arteries,  from  which  were  sent  off  two  small  vessels,  that,  from 
their  relation  to  the  cervical  vertebrae  and  to  the  cranial  bones, 
were  regarded  as  carotids,  the  corresponding  veins  being,  of 


MONSTROSITIES. 


241 


course,  regarded  as  the  jugulars.  The  main  trunk  descended 
in  front  of  the  spine,  or  a little  to  the  right  of  it,  and  gave  off 
the  intercostals ; inferiorly,  it  terminated  in  the  left  umbilical 
and  the  left  iliacs,  which  were  distributed  as  usual ; the  iliacs 
and  the  umbilical  artery  upon  the  right  side  were  perfectly 
distinct  from  those  on  the  left.  In  front  of  the  thorax,  beneath 
where  the  sternum  should  have  been,  there  was  quite  a net- 
work of  vessels.  The  structure  of  the  arteries  and  veins  was 
apparently  normal ; the  valves  in  these  last,  however,  were 
probably  wanting,  as  shown  by  the  experiment  of  inflating  the 
vessels  when  the  abdomen  was  first  opened.  In  the  thorax 
was  a quantity  of  condensed  cellular  membrane,  and  along 
the  spine  several  large  cells  filled  with  serum,  but  nothing  like 
a pleural  cavity. 

The  spinal  marrow  was  fully  exposed  by  separating  the 
wings  of  two  of  the  dorsal  vertebrae,  and  was  found  to  be  of 
the  usual  size,  the  nerves  going  off  on  each  side.  At  its 
upper  extremity  it  was  still  more  satisfactorily  shown  ; it  there 
bulged  slightly,  and  measured  four  lines  transversely,  then  be- 
coming smaller,  and  terminating  in  a blunt  point,  nerves  being 
sent  off  from  it  to  form  the  axillary  plexus,  which  was  large 
on  each  side.  Within  the  thorax  and  abdomen  were  found 
several  ganglia  of  the  sympathetic  nerve.  Muscles  of  the 
trunk  and  lower  extremities  sufficiently  developed,  but  else- 
where imperfect. 

The  skeleton  (No.  759)  having  been  prepared,  and  mounted, 
has  been  represented  in  Fig.  4,  at  the  end  of  the  volume. 
There  are  nineteen  vertebrse,  besides  the  sacral ; three,  situ- 
ated above  the  upper  rib,  are  partially  united,  and  the  bodies  of 
two  or  three  of  the  upper  dorsal  are  irregularly  ossified,  but 
the  rest  are  well  developed.  Nine  ribs  on  the  left  side,  and 
ten  on  the  right;  these  last  having  hardly  a trace  of  cartilage, 
but  otherwise  are  not  remarkable.  The  sternum  is,  of  course, 
cartilaginous,  but  consists  of  two  lateral  portions,  which  are 
widely  separated,  except  at  the  lower  extremity,  where  they 
are  closely  approximated  but  do  not  unite  ; the  portion  which 
is  upon  the  left  side  is  attached  to  the  clavicle,  and  to  the  car- 
tilages of  the  ribs,  but  on  the  right  to  the  clavicle  only.  There 
is  a scapula  on  each  side,  sufficiently  large,  although  not  well 
formed,  the  right  being  the  most  perfect.  The  clavicles  are 
31 


242 


MONSTROSITIES. 


short,  stout,  and  bent  to  somewhat  of  an  angular  form.  The 
right  upper  extremity  wants  the  humerus,  but  there  is  a slender 
bone,  about  an  inch  in  length,  which  is  evidently  the  ulna,  and 
attached  to  this  is  a small  cartilage,  which  may  represent  the 
head  of  the  radius,  these  being  directly  attached  to  the  scapula 
by  ligament ; the  carpus  exists,  but  the  distinct  parts  were  not 
made  out.  There  are  two  metacarpal  bones,  about  five  lines 
in  length  ; one  is  slender,  and  connected  with  the  long  finger 
above  mentioned,  and  which  has  three  well  developed  pha- 
langes ; the  other  is  broad  and  stout,  and  bifurcates  so  as  to 
connect  with  both  fingers,  of  which  the  short  one  has  two  pha- 
langes. The  left  upper  extremity  consisted  of  two,  small,  ir- 
regular cartilages,  followed  by  a perfectly  well  developed  me- 
tacarpal bone,  and  three  phalanges.  The  pelvis  and  lower 
extremities  are  well  formed,  except  that,  as  appeared  exter- 
nally, the  feet  are  turned  in,  and  have  only  four  metatarsal 
bones  and  toes  ; one  of  the  cuneiform  bones,  also,  is  misplaced, 
being  set  back  behind  the  others. 

Connected  with  the  upper  extremity  of  the  spinal  column  is 
a row  of  eight  small  bones ; they  are  altogether  one  inch  in 
extent,  and,  for  the  most  part,  exceedingly  irregular,  but  the 
terminal  bone  ends  distinctly  in  an  alveolus,  in  which  are  seen 
the  well  developed  crowns  of  two  incisor  teeth,  besides  a 
smaller  one,  which  is  connected  with  one  of  them  laterally. 

This  chain  of  cranial  bones  terminated  in  the  external  fleshy 
protuberance  above  mentioned,  and  the  teeth  were  contained 
in  a cavity  in  the  lower  point,  probably  the  dental  sac.  The 
protuberance  was  generally  fleshy  to  the  feel,  and  had  some 
dark  hair  about  it.  Between  the  upper  and  lower  portions 
were  two  small  openings,  which  led  backwards  into  two  distinct 
cavities,  three-fourths  of  an  inch  in  extent,  large  enough  to 
admit  a probe,  and  ending  in  a cul  de  sac,  the  inner  surface 
being  smooth  and  polished,  except  just  within  the  openings, 
where  it  was  thickened  and  rough ; taken  in  connection  with 
the  bones  about  them,  and  especially  with  the  teeth,  these  may 
fairly  be  called  nasal  cavities,  the  development  being  altogether 
very  remarkable  for  this  form  of  monstrosity. 

75S.  Cast  in  plaster  of  the  above  monstrosity,  taken,  before  the 
dissection,  by  Dr.  O.  W.  Holmes. 


MONSTROSITIES. 


243 


759.  Skeleton  of  the  same. 

760.  Colored  drawing,  to  show  the  course  of  the  circulation  from 
the  same ; the  sketch  in  the  Medical  Journal,  above  quoted, 
having  been  taken  from  this,  as  that  of  the  external  appear- 
ances was  from  the  lithographic  drawing. 

Dr.  Jeffries  Wyman. 

761.  Small  intestine  injected,  to  show  the  termination  in  a cul  de 
sac  ; from  the  same. 

762.  A cast  in  plaster  of  a second  acephalus ; taken  by  Dr.  O.  W. 
Holmes.  The  specimen  was  brought  from  Salem  by  Dr.  E.  B. 
Peirson,  in  May,  1842,  the  case  having  occurred  in  the  prac- 
tice of  Dr.  Samuel  Johnson.  The  mother  was  a mechanic’s 
wife,  and  had  previously  had  two  well-formed  children. 
Nothing  remarkable  was  noticed  in  pregnancy,  except  her 
great  size  ; labor  took  place  at  the  sixth  month,  and  was  easy. 
There  were  twins,  as  usual  in  such  cases,  and  the  monster 
was  born  first,  which,  according  to  St.  Hilaire,  almost  never 
happens.  The  second  child  was  well-formed,  but  died  in 
twelve  hours ; a large  quantity  of  liquor  amnii  was  discharged 
with  this,  but  with  the  first  none  at  all,  so  far  as  observed. 
Placenta  single,  the  cord  of  the  monstrosity  being  about  six 
inches  in  length,  and  inserted  near  the  edge. 

Externally,  this  specimen  resembled  very  nearly  the  one 
(No.  757)  already  described.  The  weight  was  four  pounds 
and  thirteen  ounces,  the  length  eleven  inches,  and  the  width, 
at  the  upper  part,  six  inches.  Integuments  excessively  oede- 
matous,  but  there  were  no  cysts,  as  in  the  last  case.  Feet 
turned  in,  and  the  toes  imperfect,  but  the  lower  extremities 
were  otherwise  well  developed.  There  was  some  vestige  of 
the  right  hand,  but  only  a pit  upon  the  surface  in  the  place  of 
the  left.  A small,  fleshy  protuberance,  as  usual  in  these  cases, 
represented  the  head,  and  around  it  was  some  appearance  of 
hair.  Immediately  below  this  protuberance,  and  almost  con- 
cealing it,  was  a remarkable  development  of  pia  mater;  it 
formed  a soft,  dark  red,  circular,  flattened,  pedunculated  mass, 
sixteen  lines  in  diameter,  and  about  three  lines  in  thickness, 
the  base  being  about  eight  lines ; it  was  covered  by  serous 


244 


MONSTROSITIES. 


membrane  alone,  and  consisted  of  a uniform,  dark  red,  spongy 
tissue,  such  as  is  found  upon  the  base  of  the  cranium,  in  the 
common  “ acephalous  foetus.”  There  was  nothing  between 
this  mass  and  the  cellular  tissue  which  filled  the  cavity  of  the 
thorax,  and  there  was  no  trace  of  cerebral  substance.  This 
formation  is  not  mentioned  by  St.  Hilaire,  but  Beclard  (Art. 
Monstruosite,  Diet,  des  Sc.  Med.)  has  described  something  of 
the  kind. 

On  dissection,  there  was  found  no  trace  of  heart,  lungs,  thy- 
mus gland,  liver,  spleen,  pancreas,  or  diaphragm.  The  umbil- 
ical vein  was  fully  injected  from  the  trunk  (No.  763),  and 
showed  no  appearance  of  valves  ; it  sent  branches  to  the  lower 
extremities,  and  to  the  abdomen ; then  ascended  along  the 
spine,  and  divided  to  supply  the  upper  extremities  and  the 
neighboring  parts  ; one  large  branch  entered  the  spinal  canal, 
upon  the  right  side,  between  two  of  the  lumbar  vertebrae. 
There  were  two  umbilical  arteries,  which  were  distributed  as 
in  the  last  case  (No.  757),  the  left  being  connected  with  the 
aorta,  which  divided  at  the  upper  part  of  the  spine  like  the 
vein,  and  at  the  lower  part  gave  off  the  usual  vessels  to  the 
pelvis,  and  to  the  left  lower  extremity  ; the  umbilical  artery  upon 
the  right  side,  and  its  branches,  appeared  to  be  distinct  from 
those  on  the  left. 

The  mode  of  circulation  in  these  cases  has  never  been  satis- 
factorily determined,  from  the  want  of  sufficient  facts.  Sir  A. 
Cooper,  however,  has  shown  (Guy’s  Hosp.  Reports,  No.  xi.) 
that  in  one  case,  at  least,  it  must  have  been  carried  on  through 
the  monstrosity  by  the  heart  of  the  perfect  foetus,  the  placenta 
being  single,  as,  according  to  St.  Hilaire,  it  generally  is,  and 
the  umbilical  arteries  of  the  two  foetuses  communicating 
freely,  so  that  the  blood  entered  the  monstrosity  by  these  ves- 
sels, and  was  returned  by  the  veins,  contrary  to  its  usual 
course.  With  regard  to  the  absence  of  valves,  in  the  present 
case,  Sir.  A.  C.  noticed  the  same  fact  in  one,  if  not  both,  of 
the  subjects  which  he  dissected,  and  St.  Hilaire  mentions 
another  case,  being,  as  he  says,  the  only  one  in  which,  so  far 
as  he  knows,  this  point  has  been  examined. 

The  large  intestine  was  ten  inches  in  length ; small  intestine 
fifteen  inches,  and  ending  in  a cul  de  sac,  there  being  two  dila- 
tations of  the  lower  part  of  the  ileum,  from  one  of  which  arose  a 


MONSTROSITIES. 


245 


marked  diverticulum  ; anus  open.  There  was  a considerable 
quantity  of  nearly  colorless  mucus,  with  some  white,  curdy 
flakes,  and  in  the  small  intestine  some  traces  of  a greenish 
color.  The  renal  capsules  were  small,  and  united  across  the 
spine  like  a horse-shoe  kidney.  Left  kidney  large  ; measured 
thirteen  by  sixteen  lines,  and  seemed  to  be  distended  with 
urine ; right  kidney  five  by  nine  lines.  The  bladder  was 
rather  small,  but  contained  urine.  The  testicles,  gubernacula, 
vasa  deferentia,  prostate,  verumontanum  and  penis  were  suffi- 
ciently well. 

The  ganglia  of  the  sympathetic  nerve,  and  the  filaments 
connecting  them  were  unusually  developed  in  the  thorax,  ab- 
domen and  pelvis  ; in  the  thorax  were  two  ganglia  which  ex- 
tended from  the  upper  rib  to  about  the  eighth  rib  upon  the  right 
side,  and  to  the  sixth  on  the  left.  The  spinal  marrow  was 
sufficiently  developed,  as  were  the  intercostal  nerves,  and  the 
nerves  in  the  lower  extremities.  The  right  brachial  nerve  was 
rather  large,  and  it  was  one  of  the  most  remarkable  points  in 
the  whole  anatomy,  that  although  there  was  no  trace  upon  the 
left  side  either  of  a clavicle  or  upper  extremity,  not  even  in  the 
cartilaginous  state,  yet  there  was  a very  tolerably  developed 
nerve,  artery  and  vein  running  down  in  connection,  in  the  sit- 
uation and  direction  which  the  extremity  would  have  taken  if 
it  had  existed. 

The  skeleton,  having  been  partially  prepared,  and  preserved 
in  that  state,  there  were  found  to  be  eleven  ribs  on  the  left  side 
and  twelve  on  the  right ; all  well  formed,  except  the  three  first 
on  the  right  side,  which  were  fused  anteriorly.  The  dorsal 
vertebrae  corresponded  to  the  ribs,  the  fourth  being  incomplete 
on  the  left  side ; cervical  vertebrae  about  three  in  number,  but 
not  exactly  determined,  the  wings  being  fused,  although  the 
transverse  processes  were  tolerably  distinct ; ten  vertebrae  be- 
low the  dorsal,  of  which  five  may  be  regarded  as  lumbar,  and 
five  as  sacral ; and  below  these  last  was  a hard,  thick,  blunt 
cartilage,  in  place  of  a coccyx.  The  sternum  was  in  two 
lateral  portions,  widely  separated,  sufficiently  and  about  equally 
developed.  The  right  upper  extremity  was  about  three  inches 
in  length ; there  was  one  metacarpal  bone,  with  its  phalanges 
well  developed  and  ossified,  and  above  these  two  irregular  carti- 
lages ; upon  the  left  side,  as  above  stated,  no  clavicle,  and  no  trace 


246 


MONSTROSITIES. 


of  an  upper  extremity.  Pelvis  well  formed.  Lower  extremities 
sufficiently  developed,  strongly  rotated  inwards,  and  the  feet 
turned  in ; head  of  each  femur  quite  prominent  anteriorly,  as 
if  partially  dislocated,  and  the  synovial  membrane  seemed 
universally  adherent.  On  the  left  foot  there  were  four  toes, 
the  fourth  metatarsal  bone  being  cartilaginous  and  quite  slender ; 
six  tarsal,  the  third  cuneiform  being  wanting.  On  the  right 
foot,  on  which  there  were  three  toes,  there  were  two  metatarsal 
bones  well  developed,  and  two  which  were  very  imperfect  and 
cartilaginous  ; tarsal  as  on  the  left  side. 

763.  Veins  of  the  above  monstrosity ; injected,  dissected  out,  and 
displayed  upon  a black  board. 

764.  Intestinal  canal,  from  the  same  case,  and  prepared  like  the 
veins. 

765.  A third  specimen  of  acephalus,  preserved  entire  in  spirit.  It 
is  smaller  than  the  two  others,  the  length  being  from  six  to 
seven  inches.  The  lower  extremities  are  well  developed,  but 
the  feet  are  much  distorted,  there  being  only  two  toes  on  the 
left,  and  three  on  the  right.  No  trace  of  upper  extremities. 
Sex  female,  anus  not  open.  Hernia  of  intestine  into  the  cord. 
Just  above  the  cord,  and  rather  to  the  left  of  the  median  line,  is 
a very  soft,  fleshy,  rounded  protuberance,  about  one-third  of 
an  inch  in  diameter.  Integuments  very  cedematous,  as  usual. 

One  well  formed  child  was  born,  and  afterwards  the  mon- 
strosity, which  presented  by  the  feet.  Quantity  of  liquor  amnii 
large,  there  being  a separate  discharge  for  each  fcetus.  Pla- 
centa single  ; cord  of  the  monstrosity  slender,  but  that  of  the 
child  was  quite  large.  Labor  occurred  at  the  sixth  month,  and 
was  otherwise  natural ; the  child  living  a few  hours  only. 
1842.  Dr.  M.  S.  Perry. 

766-74.  Specimens  illustrating  one  of  the  varieties  of  that  form 
of  monstrosity  which  is  commonly  known  as  the  “ Acephalous 
Fcetus.”  The  specimens  are  so  similar,  that  one  general  de- 
scription may  answer  for  the  whole,  and  with  these,  have  been 
incorporated  notes  of  seven  others  which  have  also  been  ob- 
served, the  cranial  bones  of  several  of  them  having  been  pre- 
served in  the  Cabinet. 


MONSTROSITIES. 


247 


Externally,  this  variety  of  monstrosity  is  characterized  as 
follows: — The  trunk  and  extremities  were  well  formed  and 
fully  developed ; the  vault  of  the  cranium  was  wanting,  and 
the  base  of  the  skull  was  covered  by  a deep  red,  smooth,  but 
somewhat  irregular,  serous  surface,  this  surface  extending  down 
the  neck,  sometimes  as  low  as  the  middle  of  the  back,  and 
terminating  in  a point ; on  the  margin  of  the  integument, 
about  the  base  of  the  cranium,  was  a narrow  strip  of  hair ; the 
neck  was  short,  the  ears  rested  on  the  shoulders,  and  turned 
forwards  over  the  meatus,  the  face  was  directed  upwards  in 
proportion  to  the  malformation  of  the  neck,  the  mouth  was 
open,  and  the  prominent,  staring,  frog-like  eyes  were  situated 
almost  upon  the  top  of  the  head. 

On  cutting  through  the  arachnoid  membrane,  over  the  base 
of  the  cranium,  for  so  it  must  be  called,  a coarse  lace-wrork  of 
vessels  w'as  found,  consisting  of  pia  mater,  and  very  much 
congested ; but,  although  the  thickness  of  this  vascular  sub- 
stance varied  in  different  subjects,  and  still  more  in  different 
parts  of  the  same,  there  was  nothing  that  could  be  called  a 
tumor,  as  described  by  St.  Hilaire  (Hist,  des  Anomalies,  vol.  ii. 
p.  336.)  In  eight  of  the  cases  above  referred  to,  there  was  no 
trace  of  brain ; in  one  there  was  a doubtful  trace,  but  in  four 
there  were  distinct  traces  of  cerebral  substance  in  the  pia 
mater. 

St.  H.  remarks  (vol.  ii.  p.  339)  that  his  father  and  M.  Serres 
discovered  the  pituitary  gland  in  one  case  ; in  the  above  cases, 
I found,  no  less  than  six  times,  a rounded  body  about  the  size 
of  that  gland,  and  precisely  in  its  situation,  but  although  some- 
times soft  like  brain,  it  more  commonly  had  almost  the  fleshy 
consistence,  as  it  had  the  color,  of  a lymphatic  gland ; and 
these  were  not  all,  for  the  same  wTas  also  found  three  times  in 
the  other  varieties  of  this  form  of  monstrosity.  The  cerebral 
character  of  this  body  being  then  rather  doubtful,  it  was  ex- 
cluded in  speaking  of  the  brain. 

The  spinal  marrow  terminated  about  where  the  serous  sur- 
face began,  but  could  sometimes  be  traced  a little  way  upon 
the  membranes,  as  a thin  expansion  ; below  this,  whenever  ex- 
amined, it  was  found  to  be  fully  developed. 

Of  the  nerves  about  the  base  of  the  cranium,  the  spinal  ac- 
cessory was  generally  seen  after  a little  dissection,  and  some- 


248 


MONSTROSITIES. 


times  at  once ; branches  of  the  fifth  pair  were  several  times 
found,  and  in  one  case  there  was  some  appearance  of  the 
Cassei’ian  ganglion  ; the  other  nerves,  when  seen,  were  so  in- 
volved in  the  cellulo-vascular  tissue  that  they  could  not  be 
traced  to  their  foramina. 

The  internal  organs  of  the  thorax  and  abdomen,  in  ten  of 
the  cases  which  I examined  myself,  were  well  formed,  with 
the  following  exceptions.  The  renal  capsules,  in  every  one, 
were  very  small,  and  in  some  they  might  readily  have  been 
dissected  away  with  the  fat  which  was  found  about  the  kidneys, 
as  probably  happened  in  some  of  the  published  cases,  in  which 
they  are  stated  to  have  been  wanting.  The  same  general  fact 
in  these  cases  was  noticed  by  Mr.  Hewson  (Phil.  Trans.  1775), 
and  seems  now  to  be  generally  known,  although  I do  not  find 
that  St.  Hilaire  refers  to  it.  In  one  there  was  a supernumerary 
artery  at  the  arch  of  the  aorta ; in  another  there  was  but  one 
umbilical  artery ; in  one  the  heart  was  malformed  (No.  340), 
and  in  one  the  diaphragm  was  almost  entirely  wanting  upon 
the  right  side,  the  liver  encroaching  upon  the  thorax,  and  the 
right  lung  being  no  larger  than  the  upper  lobe  usually  is.  In 
one  (No.  773)  there  were  several  peculiarities  that  will  be  no- 
ticed hereafter.  In  two,  of  which  I did  not  see  the  dissection, 
the  internal  organs  were  well  formed,  except  that  the  renal 
capsules  were  very  small,  and  in  one  of  the  subjects  one  of 
them  was  not  found. 

The  cranium  was  very  remarkable  in  these  cases,  and  the 
general  form  varied  so  little  that  one  representation  (Figure  5) 
will  suffice  for  the  whole.  The  frontal  bones  (a.  a.)  were  very 
imperfectly  developed  in  all,  forming,  as  it  were,  a part  of  an 
irregular  bony  circle  or  ring ; the  nasal  processes,  however, 
were  always  quite  large.  In  connection  with  these  bones  may 
be  mentioned  the  extreme  shallowness  of  the  orbits,  causing 
the  eyes  to  protrude  and  appear  large,  as  they  are  generally 
described,  although,  when  dissected  out,  they  were  found  to  be 
no  larger  than  usual.  The  parietals  were  wanting  in  every 
case,  excepting  one  (No.  769),  in  which  they  existed  in  a very 
rudimentary  state.  The  occipital  bone  was  the  most  remark- 
able ; the  basilar  and  lateral  portions  were  sufficiently  devel- 
oped, although  not  always  well  formed,  and  the  last  two  were 
directed  horizontally  outwards,  and  sometimes  even  a little 


MONSTROSITIES. 


249 


downwards ; the  posterior  portion,  as  seen  in  the  figure,  is  di- 
vided into  two  equal  portions  ( b . b.,)  which  are  of  a very  pe- 
culiar form,  and  are  widely  separated,  so  as  to  form  on  each  side 
the  lateral  margin  of  the  cranium.  The  petrous  portion  of  the 
temporal  bone  was  always  large  and  quite  prominent ; passage 
for  the  carotid  artery  sufficiently  large,  but  short  and  direct  in 
its  course,  instead  of  being  circuitous  as  usual ; squamous 
portion  very  imperfectly  developed,  and  situated  rather  beneath 
the  cranium  than  upon  its  side  ; the  ossicula  were  sufficiently  de- 
veloped, but  the  stapes  was  often  more  or  less  distorted.  The 
great  wings  of  the  sphenoid  bone  are  distinct  from  the  body,  in 
a foetus  at  the  term,  whereas,  in  the  above  cases,  the  left  wing 
was  co-ossified  in  two,  the  right  in  three,  and  in  five  they  were 
both  united  to  the  body  of  the  bone  ; pterygoid  processes  quite 
large  ; small  wings  scarcely  developed,  having,  in  some  cases, 
long  slender  spines,  directed  anteriorly,  and  in  others  being 
united  posteriorly  with  the  body  of  the  bone,  so  as  to  make 
two  distinct  foramina  behind  the  optic  ; these  last,  and  those 
for  the  fifth  pair  of  nerves  were  sufficiently  developed.  The 
two  superior  maxillary  bones,  -which  should  be  distinct,  were 
co-ossified  anteriorly  in  nine  of  the  above  cases,  and  in  one  of 
two  cases,  in  which  they  were  separate,  the  two  inferior  max- 
illary bones  were  co-ossified,  this  being  the  only  instance  in 
which  this  unusual  condition  was  observed.  The  other  bones 
of  the  head  were  not  remarkable ; the  inferior  maxillary  is 
sometimes  spoken  of  as  larger  than  usual,  but  it  only  appears 
so  from  the  deficiency  of  the  cranial  bones. 

The  malformation  of  the  spine,  which  existed  in  all,  was 
confined  to  the  neck  in  some,  but  extended,  in  others,  as  low 
as  the  middle  of  the  back,  the  wings  of  the  vertebra  being 
widely  separated,  unequally  developed,  and  often  more  or  less 
co-ossified ; the  bodies,  also,  were  very  often  irregularly  de- 
veloped. Some  of  the  ribs  were  generally  co-ossified  when 
there  was  much  malformation  of  the  spine.  Skeleton,  other- 
wise, well  formed.  The  osteology  will  be  fully  illustrated  in 
the  four  following  specimens,  which  are  a part  of  those  above 
described. 

There  are  some  other  interesting  circumstances  in  the  his- 
tory of  these  cases,  which  should  not  be  omitted.  With  regard 
to  the  sex,  five  were  males  and  eight  were  females.  In  seven 
32 


250 


MONSTROSITIES. 


the  birth  was  premature,  and  one  only  is  stated  to  have  been 
born  at  the  full  term.  One  presented  by  the  arm,  but  the  child 
was  readily  turned,  and  delivered  by  the  feet ; a second  pre- 
sented by  the  feet ; a third,  by  the  head,  but  the  face  was  to 
the  pubes  ; five  by  the  head,  and  in  these,  and  all  of  the  others, 
the  presentation  must  have  been  natural,  or  the  contrary  would 
have  been  stated  ; and  a similar  observation  might  be  made  in 
regard  to  many  other  points,  all  of  the  positive  facts  of  any 
importance  having  been  obtained,  in  nearly  every  case.  Three 
were  reported  still  born,  and  so,  I am  quite  sure,  they  all  were, 
or  that  they  gasped  but  a few  times  at  the  most.  A very  curious 
fact,  which  was  noticed  in  this,  and  in  another  variety  of  this 
form  of  monstrosity,  and  almost  universally,  was  a profuse 
discharge  of  what  has  been  regarded  as  the  liquor  amnii ; it  is 
recorded,  however,  only  eight  times  in  the  first  variety ; 
Lallemand  has  observed  the  same  fact  in  an  analogous  case, 
and  attributed  it  to  the  dropsical  affection  which  he  supposed  to 
have  destroyed  the  brain  and  spinal  marrow.  In  regard  to 
previous  births,  one  case  was  that  of  a first  child,  but  in  seven 
there  had  been  other  children,  and,  for  the  most  part,  a large 
number.  St.  Hilaire  seems  to  attach  much  importance  to  the 
occurrence  of  some  cause  acting  upon  the  mother,  in  the  early 
months  of  pregnancy,  and  tending  to  produce  the  monstrosity 
(II.  pp.  345  and  369 ;)  in  one  of  the  above  cases,  the  mother 
attributed  it  very  decidedly  to  a severe  fright ; in  four  others, 
no  cause  could  be  assigned,  and  in  the  remainder  the  fact  is 
not  noticed. 

766.  A mounted  skeleton  of  an  “Acephalous  Foetus;”  this  is  the 

specimen  which  is  represented  in  Figure  No.  5.  1839. 

Dr.  J.  C.  Hayden. 

767.  A set  of  separated  bones  of  the  head  and  part  of  the  spine,  of 

an  acephalous  fcetus  ; mounted  individually  upon  pedestals,  and 
placed  upon  a black  board.  1839.  Dr.  J.  D.  Fisher. 

768.  A second  specimen,  similar  to  the  last,  but  showing  also  a 

fusion  of  the  ribs.  1841.  Dr.  George  C.  Shattuck. 

769.  A third  specimen ; in  this  there  are  two  rudimentary  and  very 


MONSTROSITIES. 


251 


irregular  bones,  that  are  connected  with  the  frontal,  and  proba- 
bly represent  the  parietal  bones.  1842. 

Dr.  William  E.  Townsend. 

770.  Drawings,  showing  the  external  appearances  of  an  acephalous 
foetus.  Two  of  them  represent  in  outline  a front  and  side  view 
of  the  head  and  shoulders,  and  the  third  gives  a back  view  of 
the  whole  in  India  ink,  the  head  being  shaded.  They  were 
taken  by  a professed  artist,  for  Dr.  Charles  T.  Hildreth,  and, 
being  admirably  well  done,  might  be  copied  here,  if  this  form 
of  monstrosity  were  not  sufficiently  well  known  ; the  only  repre- 
sentations, however,  that  I have  seen  of  it  are  two  wretched 
figures,  one  in  St.  Hilaire’s  work  (Hist,  des  Anom.,)  and  the 
other  in  a Memoir  by  V.  Portal  (Annales  des  Sciences  Nat. 
vol.  xiii.). 

771.  Cranium  of  the  monstrosity,  from  which  the  above  drawings 
were  taken  ; prepared  by  Dr.  C.  T.  Hildreth.  The  skeleton 
has  also  been  preserved,  but,  being  in  an  imperfect  state,  it  has 
not  been  mounted  with  the  cranium ; it,  however,  shows  an 
extensive  fusion  of  the  ribs,  and  separation  of  the  wings  of  the 
vertebrae  as  low  as  the  eighth  dorsal.  1835. 

772.  A foetus  preserved  in  spirit,  and  showing  the  full  development 
and  plump  condition  so  often  noticed  in  these  cases.  Dissected 
by  Dr.  Joseph  W.  McKean.  1828. 

773.  A foetus  preserved  in  spirit,  and  which  had  been  in  spirit  for 
some  time  when  it  was  dissected.  The  case,  which  is  interest- 
ing from  the  malformation  of  the  internal  organs,  and  from  the 
circumstances  of  its  birth,  occurred  in  the  practice  of  Dr.  Ezra 
Palmer,  Jr.,  and  an  account  of  it  was  published  by  him  in  the 
Medical  Magazine  for  December,  1833. 

The  deficiency  of  the  vertebra  extended  to  about  opposite 
the  lower  angles  of  the  scapulae,  the  brain  being  nearly  want- 
ing. Left  upper  and  right  lower  extremities  imperfectly  de- 
veloped ; feet  turned  in,  as  in  varus.  Something  like  a penis 
was  seen,  about  one-third  of  an  inch  in  length,  and  having  the 
appearance  of  an  urethra,  which  terminated  almost  at  once  in 
a cul  de  sac,  but  there  was  no  prepuce  nor  scrotum,  neither 


252 


MONSTROSITIES. 


did  the  anus  exist,  nor  the  sulcus  between  the  nates.  Other- 
wise the  foetus  externally  was  well  formed. 

The  abdomen  was  much  distended,  and,  when  the  specimen 
was  fresh,  there  was  supposed  to  be  ascites ; the  peritoneal 
cavity,  however,  on  being  opened,  was  found  to  contain  a few 
ounces  only  of  a reddish  brown  fluid.  The  urinary  bladder 
was  as  large  as  a common-sized  orange,  considerably  thick- 
ened, and  filled  about  one-third  of  the  cavity  of  the  abdomen, 
the  urethra  being  pervious  to  the  extent  of  about  two-thirds  of 
an  inch.  Kidneys  and  renal  capsules  small,  but  the  ureters 
were  tortuous,  and  very  much  dilated.  The  large  intestine 
opened  into  the  upper  back  part  of  the  bladder,  and  upon  its 
left  side,  being,  for  the  last  two  inches,  distended  with  meco- 
nium. At  the  fundus  of  the  bladder,  and  connected  intimately 
with  its  parietes,  were  the  rudiments  of  a uterus;  these  con- 
sisted of  three  cavities,  one  of  them  about  two-thirds  of  an 
inch  in  diameter,  and  the  other  two  about  half  as  large,  the 
largest  being  situated  immediately  upon  the  right  side  of  the 
intestine,  and  the  two  others  close  to  it,  but  upon  the  other  side; 
they  were  about  a line  in  thickness,  rugous  upon  the  inner 
surface,  and  opened  freely  into  the  cavity  of  the  bladder,  two 
of  them  by  distinct  openings,  and  the  third  indirectly  through 
one  of  the  others ; from  each  side  there  was  sent  off  a pro- 
longation, or  horn,  which  terminated  in  a short  Fallopian  tube, 
and  beneath  which  was  a well  developed  ovary.  The  other  or- 
gans of  the  abdomen  were  well  formed,  and  have  been  removed, 
except  the  large  intestine  ; the  thoracic  organs  were  also  well 
formed.  In  the  preparation,  the  anterior  parietes  of  the  abdo- 
men and  of  the  urinary  bladder  having  been  cut  away,  there 
are  seen  the  openings  from  the  intestine  and  from  the  uterine 
cavities  into  the  bladder,  the  appendages  of  the  uterus,  and  the 
dilated  ureters,  these  last  being  injected. 

This  foetus  was  born  in  company  with  two  others,  which  were 
well  formed ; the  first,  a male,  weighed  seven  pounds,  and  did 
well ; the  second,  the  subject  of  the  present  case,  weighed  five 
pounds,  and  gasped  only  a few  times  after  it  was  expelled ; 
the  third,  a female,  weighed  six  pounds,  and  lived  for  ten  hours. 
The  two  first  presented  by  the  breech,  but  the  presentation  of 
the  third  was  natural.  They  were  contained  in  separate  cavi- 
ties, and  the  placenta,  which  was  single,  weighed  two  pounds. 


MONSTROSITIES. 


253 


The  mother  was  a respectable,  middle  aged  woman,  and  had 
four  children  previously  to  her  confinement  with  the  triplets. 
1835. 

774.  Cast  in  plaster  of  the  head  of  an  acephalous  foetus,  taken  by 
Dr.  Morrill  Wyman,  of  Cambridge.  The  child  was  born  at 
six  o’clock,  A.  M.,  on  the  25th  of  August,  1843,  and  died  in  the 
course  of  the  forenoon  of  the  30th,  having  lived  more  than  five 
days.  During  this  time  it  appeared  very  feeble,  and  in  the 
most  miserable  state  possible ; it,  however,  opened  its  eyes, 
moved  its  lips,  protruded  the  tongue  to  the  edge  of  the  lips, 
and  took  liquids  from  a sop,  but  would  not  suck.  It  also  moved 
the  limbs.  It  was  small,  but  externally  well  formed,  except 
for  a reddish  mass,  which  exuded  serous  fluid,  and  was  situated 
about  midway  between  the  eyes  and  the  occiput.  The  case 
occurred  in  the  practice  of  Dr.  T.  Wellington,  of  West 
Cambridge. 

775.  The  cranium  of  an  acephalous  foetus,  which  differed  from  all 
of  those  above  described  (p.  246,)  in  having  the  spine  entire 
throughout,  and  in  having  the  posterior  portion  of  the  occipital 
bone  only  partially  divided,  as  shown  in  Figure  6.  The  pari- 
etal bones  were  wanting,  and  the  cranium  was  otherwise  formed 
as  in  the  above  cases,  excepting  that  it  was  more  elongated 
than  usual. 

Externally,  the  foetus  was  well  developed,  and  well  formed, 
excepting  the  head ; the  neck  being  sufficiently  long,  the 
ears  were  not  bent  forwards  as  in  the  other  cases  ; weight  five 
and  a half  pounds ; sex  male  ; born  at  the  full  period,  and 
presented  by  the  lower  extremities,  which  moved  when  they 
were  first  felt  in  the  vagina,  though  the  child  never  breathed  ; 
quantity  of  liquor  amnii  very  great.  The  mother  had  pre- 
viously had  six  or  seven  children,  and  assigned  no  cause  for  the 
monstrosity. 

Upon  the  base  of  the  cranium  was  an  irregular,  dark  red 
mass,  nearly  as  large  as  an  English  walnut,  one  rounded,  pe- 
dunculated body  hanging  down  over  the  left  eye  ; on  dissec- 
tion, this  consisted  of  a coarse,  reticulated  structure,  with  some 
large  blood-vessels,  and  numerous,  small,  serous  cysts,  but 
without  a trace  of  cerebral  substance.  The  spinal  marrow 


254 


MONSTROSITIES. 


terminated  just  above  the  base  of  the  skull,  in  four  little  rounded 
eminences,  and  was,  at  the  same  time,  rather  enlarged.  Renal 
capsules  exceedingly  small,  but  the  internal  organs  were 
otherwise  well  formed.  1838.  Dr.  George  Bartlett. 

776-81.  The  next  six  specimens  belong  to  another  variety  of  the 
“ Acephalous  Foetus,”  which  resembles  the  one  already  de- 
scribed (p.  246,)  in  its  general  characters,  but  differs  from  it 
much  in  the  degree  of  malformation ; the  spine  is  open 
throughout,  and  is  often  incurvated  so  as  to  add  very  much  to 
the  external  deformity ; there  are  also  more  frequently  than  in 
the  first  variety  other  malformations,  both  external  and  inter- 
nal ; the  cranium,  however,  remains  about  the  same,  although 
there  is  more  development  of  brain. 

776.  A mounted  skeleton,  being  the  first  specimen  in  this  series. 
The  spine  was  perfectly  straight,  except  at  the  upper  lumbar 
vertebra,  where  there  was  a slight  anterior  curvature,  but  this 
is  not  now  to  be  seen ; all  of  the  vertebrae  are  well  developed, 
except  the  wings  of  the  third  cervical,  which  are  quite  small ; 
the  wings  of  the  dorsal  vertebrae,  also,  not  being  so  widely 
open  as  usual  in  this  form  of  monstrosity.  Otherwise  the 
skeleton  is  well  formed,  excepting  the  head,  as  externally,  the 
subject  was  well  formed,  except  for  the  head  and  spine. 

A trace  of  brain  only  existed,  if  any  at  all,  but,  in  the  situa- 
tion of  the  pituitary  gland,  there  was  found  a soft,  rounded, 
reddish  mass,  in  this  case,  and  in  No.  778  ; there  was  some 
appearance,  also,  of  a thin  and  superficial  layer  of  medullary 
substance  in  place  of  the  spinal  marrow ; and  the  same  has 
been  sometimes  observed  in  other  similar  cases  ; spinal  nerves 
and  ganglia  well  developed,  as  they  usually  are  in  these  cases. 
The  internal  organs  were  well  formed,  except  for  the  small 
size  of  the  renal  capsules,  and  a fissure  of  the  uvula ; this  last 
was  also  observed  in  Nos.  781  and  783,  and  twice  in  the 
first  variety  of  the  acephalous  fcetus  (p.  246,)  the  soft  palate 
being  otherwise  well  developed. 

This  case  occurred  in  November,  1844 ; the  mother  was  a 
young  married  woman,  and  this  was  her  first  child  ; no  acci- 
dent during  pregnancy ; considered  herself  as  in  the  sixth 
month  when  labor  came  on,  without  any  obvious  cause  ; breech 


MONSTROSITIES. 


255 


presentation ; child  still  bom ; quantity  of  liquor  amnii 
large.  Dr.  Benjamin  E.  Cottuig,  of  Roxbury. 

777.  A mounted  skeleton;  the  second  specimen  in  this  series 
(p.  254.)  Cranium  as  in  the  first  variety  (p.  246,)  except  that 
there  are  two  long,  slender  bones,  finely  serrated  on  their 
edges,  closely  connected  with  the  frontals,  and  which  may 
perhaps  be  rudimentary  parietal  bones ; the  same  have  been 
figured  in  the  case  of  No.  781,  and  also  by  Lallemand,  in  his 
case  above  referred  to  (Observations  Pathologiques,  1825.) 

The  cervical  portion  of  the  spine  is  bent  directly  downwards 
and  backwards,  so  that  the  upper  dorsal  vertebra  forms  the 
proper  summit  of  the  spinal  column,  and,  in  the  recent  speci- 
men, the  posterior  edge  of  the  base  of  the  cranium  was  united 
by  fibrous  substance  to  the  wings  of  the  sixth  dorsal  vertebra ; 
wings  of  the  cervical  and  dorsal  vertebrae  extensively  co-ossi- 
fied.  Skeleton  otherwise  well  formed. 

When  recent,  a large  and  somewhat  lobulated  mass  of  cere- 
bral substance  was  found,  and  there  was  some  appearance  of 
spinal  marrow.  The  specimen  was  then  put  in  spirit,  and  after 
some  time  was  taken  out  and  hastily  examined ; the  internal 
organs  were  well  formed,  except  for  the  renal  capsules,  which 
were  not  found  ; the  entire  absence  of  these  organs  is  so  con- 
trary to  what  has  been  generally  observed,  that  I think  there 
must  have  been  an  oversight  in  this  case,  the  examination 
having  been  made  under  very  unfavorable  circumstances. 
When  recent,  this  foetus  weighed  one  pound  and  a quarter ; 
sex  female  ; discharge  of  liquor  amnii  very  great.  1838. 

Dr.  Charles  Wild , of  Brookline. 

778.  A mounted  skeleton  ; the  third  specimen  in  this  series  (p.  254.) 
Cranium  as  in  the  last  specimen,  except  that  there  is  but  one 
so  called  rudimentary  parietal  bone,  and  that  is  quite  small  and 
attached  to  the  left  frontal  bone.  The  spine  is  nearly  doubled 
upon  itself,  the  middle  dorsal  vertebrae  projecting  forwards, 
and  the  upper  lumbar  backwards ; there  is  also  a considerable 
lateral  distortion.  The  wings  of  the  cervical  and  dorsal  ver- 
tebrae are  unequally  developed,  and  extensively  fused,  espe- 
cially upon  the  right  side;  the  bodies  also  are  very  irregular. 
Of  the  ribs,  there  are  eleven  upon  the  left  side,  and  these  are 


256 


MONSTROSITIES. 


distinct ; on  the  right,  there  are  ten  or  eleven,  and  nearly  all 
of  them  are  fused. 

Externally,  this  fostus  was  more  deformed  and  much  smaller 
than  those  already  described,  weighing  scarcely  twelve  ounces 
(avoird.)  In  consequence  of  the  strong  curvature  of  the  spine, 
the  trunk  was  much  shortened,  and  the  projection  of  the  lum- 
bar vertebrae  was  very  conspicuous.  The  parietes  of  the  ab- 
domen were  deficient  upon  the  left  side,  and  the  liver  and  in- 
testines protruded,  forming  a large  tumor,  and  covered  only  by 
a thin  membrane,  which  was  continuous  with  the  integuments. 
The  right  hand  w'as  strongly  flexed,  and  turned  so  that  its  cubi- 
tal edge  came  in  contact  with  that  of  the  fore-arm,  as  shown 
in  the  skeleton  ; the  left  foot  was,  also,  strongly  bent  outwards. 

On  dissection,  no  trace  of  cerebral  substance  was  found,  ex- 
cepting the  pituitary  body  ; no  cysts  in  the  pia  mater  ; spinal 
nerves  and  ganglia  distinct,  with  some  appearance  of  spinal 
marrow,  the  parts  being  considerably  injured  in  the  delivery, 
as  they  often  are. 

Internally,  the  diaphragm  was  wanting.  Liver  fawn-colored, 
and  the  umbilical  vein  entered  on  the  convexity  of  the  organ, 
there  being  no  division  into  lobes ; spleen,  kidneys,  bladder, 
uterus,  ovaries,  and  vagina  well  formed.  Renal  capsules 
rather  larger  than  usual  in  the  acephalous  foetus,  and  not  con- 
nected with  the  kidneys,  but  rather  above  them  and  towards 
the  median  line.  The  arch  of  the  aorta  gave  off  the  right 
subclavian  and  carotid  only ; the  pulmonary  artery  gave  off 
the  usual  branch  to  each  lung,  and  then  divided  into  two 
main  branches,  one  being  the  ductus  arteriosus,  and  the  other, 
after  running  some  way  upwards,  dividing  into  the  left  subcla- 
vian and  carotid  arteries  ; the  other  vessels,  and  the  heart,  ex- 
ternally, were  well  formed,  as  were  also  the  lungs. 

The  mother  of  this  subject  was  a young  woman,  and  had 
had  one  miscarriage,  but  had  never  carried  a child  to  the  full 
term.  Considered  herself  as  in  the  seventh  month  of  preg- 
nancy, when  the  child  was  born ; the  liquor  amnii  had  been 
coming  away  for  three  weeks,  and  in  considerable  quantity, 
the  discharge  being  profuse  towards  the  last ; back  of  the 
child  presented,  and  thus  it  came  into  the  world.  The  placenta 
was  reported  by  Dr.  S.  as  large,  and  made  up  almost  entirely 
of  serous  cysts  ; cord  exceedingly  short.  In  the  course  of  her 


MONSTROSITIES. 


257 


pregnancy,  the  mother  sent  for  Dr.  S.,  in  consequence  of  her 
anxiety  from  what  her  friends  had  said,  that  her  child  would 
resemble  a certain  dog,  to  which  she  was  much  attached,  and 
which  had  been  used  to  draw  her  breasts  after  the  previous  mis- 
carriage. This  child  was  born  on  the  30th  of  October,  1840, 
and  on  the  1st  of  December,  1841,  she  was  again  delivered  of 
another  very  similar  monstrosity,  (No.  780.) 

Dr.  Asa  B.  Snow. 

779.  This  specimen,  the  fourth  of  this  series  (p.  254,)  is  preserved 
entire,  in  spirit,  and  is  interesting  in  connection  with  the  last, 
as  it  resembled  it  perfectly  in  size,  and  its  general  outline,  and 
in  the  projection  formed  by  the  lumbar  vertebrae.  There  is 
also  the  same  deficiencies  of  protrusion  of  the  parietes  of 
the  abdomen,  with  a protrusion  of  the  contents,  the  only  differ- 
ence being  that,  in  the  present  case,  it  is  upon  the  right  side, 
whereas  in  the  other  it  was  on  the  left ; sex  male. 

Dr.  Charles  Walker. 

780.  Separated  bones  of  an  entire  skeleton,  the  spine  only  being 
preserved  as  a single  piece  ; mounted  on  pedestals,  and  dis- 
played upon  a black-board  ; the  fifth  specimen  of  this  series. 
The  right  wing  of  the  sphenoid  is  fused  with  the  body  of  the  bone. 
The  spine,  which  is  represented  in  Figure  8,  is  four  inches  in 
length,  and  nearly  straight,  open  throughout,  of  course,  but 
otherwise  well  developed  below  the  lower  dorsal  vertebra. 
The  wings  are  mostly  small,  and  more  or  less  fused  as  low  as 
the  sixth  dorsal  vertebra,  on  the  left  side,  and  rather  lower 
down,  on  the  right.  The  bodies  of  the  corresponding  vertebrae 
are  generally  very  irregularly  developed  ; most  of  the  cervical, 
with  the  two  upper  dorsal,  are  fused  into  one  mass,  and  bifid ; 
the  two  lateral  halves  being  separated  so  as  to  leave  an  open- 
ing of  considerable  size  (a.),  although  much  less  than  in  the 
next  case.  Upon  the  body  of  the  eleventh  dorsal  vertebra, 
posteriorly,  is  seen  what  appears  to  be  the  wing  of  a vertebra 
( b .),  inclining  to  the  right  side,  and  resting  immediately  upon 
a small  bone,  which  may  be  a misplaced  and  undeveloped 
body.  Of  the  ribs,  there  are  nine  upon  the  left  side,  and 
eleven  on  the  right ; many  of  them  are  fused,  and  some  are 
very  imperfectly  developed.  Extremities  well  developed, 

33 


258 


MONSTROSITIES. 


This  child  was  born  on  the  1st  of  December,  1841,  and  the 
most  remarkable  circumstance  in  the  case  was,  that,  thirteen 
months  previously,  the  mother  had  been  delivered  of  a similar 
monstrosity  (No.  778.)  Labor  occurred  at  the  eighth  month, 
and  the  presentation  was  natural ; weight  of  the  child  two 
pounds  and  nine  ounces.  She  subsequently  had  two  other, 
well  formed  children,  one  at  the  full  period,  and  one  prema- 
turely ; and  about  a fortnight  after  the  last,  in  February,  1845, 
died  of  acute  nephritis.  Dr.  Asa  B.  Snow. 

781.  The  cranium  and  trunk  of  the  sixth  specimen  in  this  series 
(p.  254 ;)  represented  in  Figure  9 ; the  extremities,  being  well 
formed,  have  been  removed.  The  head  is  inclined  to  the  right 
side,  and  carried  backwards  so  that  the  occiput  is  closely  con- 
nected with  the  wing  of  the  sixth  dorsal  vertebra  upon  the  left 
side,  and  with  the  eighth  on  the  right.  The  rudimentary  pa- 
rietal bones  (a.  a.)  exist,  as  in  No.  777,  and  there  is  a consid- 
erable separation  between  the  palatine  bones,  extending  some- 
what to  the  upper  maxillaries,  and  connected  with  a fissure 
which  was  observed  in  the  soft  palate. 

The  spinal  column  is  remarkably  malformed.  A front  view 
of  this  part  of  the  skeleton  has  been  represented  in  Figure  10, 
and  an  idea  may  be  given  of  it,  by  supposing  that  there  had 
been  a longitudinal  fissure  through  the  bodies  of  the  vertebrae, 
from  the  first  cervical  to  the  eighth  dorsal,  and  that  the  two 
lateral  portions  had  then  been  so  widely  separated  as  to  result, 
not  merely  in  a coming  together,  but  in  an  actual  fusion  of  the 
cervical  bodies  with  the  dorsal  of  the  same  side ; the  fusion 
being  more  marked  posteriorly  than  in  the  front  view.  The 
lateral  portions  do  not,  however,  come  perfectly  together,  but 
there  remains  a central  opening  (a.),  about  three  lines  in  diam- 
eter, and  surrounded  on  all  sides  by  the  bodies  of  the  vertebrae. 
Upon  the  left  side  the  third  cervical  is  in  contact  with  the 
seventh  dorsal  (&.),  and  on  the  right  side,  the  second,  third, 
fourth,  and  fifth  cervical  are  fused  into  a common  mass  with 
the  eighth  dorsal  (c.)  As  to  the  number  of  the  bodies,  there 
are  in  the  neck,  on  the  left  side,  six,  distinct  from  each  other, 
and  regularly  arranged,  the  last  two  being  fused  with  the  bodies 
of  the  dorsal  vertebrae ; on  the  right  side  are  seven,  much 
more  irregular,  and  of  which  four  are  fused,  as  above  stated. 


MONSTROSITIES. 


259 


The  body  of  the  first  upper  dorsal  vertebra,  on  the  left  side, 
exists ; the  two  next  are  wanting ; the  four  next  are  distinct, 
and  of  some  size,  and  two  of  them  certainly  are  fused  with 
the  bodies  of  the  cervical  vertebrae  ; the  eighth  and  ninth  form 
a common  large  mass,  bounding  the  central  opening  inferiorly. 
On  the  right  side,  the  bodies  of  the  dorsal  vertebrae  are  much 
more  irregular ; the  first  four  or  five  are  almost  entirely  want- 
ing ; the  sixth  and  seventh  are  of  some  size,  but  are  fused 
with  the  cervical,  and  the  eighth  is  fused  with  four  of  the  cer- 
vical, as  above  stated.  The  bodies  of  the  last  three  dorsal 
vertebrae,  and  of  the  five  lumbar,  are  well  developed,  there 
being,  however,  a slight  lateral  curvature.  Most  of  the  wings 
of  the  cervical  vertebrae  are  fused,  and  many  of  the  dorsal, 
especially  on  the  right  side.  There  are  twelve  pairs  of  ribs, 
which  are,  for  the  most  part,  closely  compressed,  as  usual  in 
these  cases ; three  of  the  lowest  are  fused  on  the  right  side, 
and  on  the  left,  they  are  generally  flattened,  but  otherwise  well 
developed. 

This  case  occurred  in  December,  1844.  The  mother  had 
previously  had  two  well  formed  children,  and  considered  her- 
self as  in  the  sixth  month  of  pregnancy,  when,  without  any 
obvious  cause,  labor  came  on  ; breech  presentation  ; child  still 
born ; sex  female  ; quantity  of  liquor  amnii  very  large.  The 
deformity  of  the  trunk  was  very  considerable,  but  the  extremi- 
ties were  well  developed.  Upon  the  base  of  the  skull  were 
some  traces  of  brain,  and,  in  place  of  the  spinal  marrow,  a 
layer  of  medullary  substance,  thin,  but  of  some  width,  and 
covered,  if  at  all,  by  the  most  delicate  membrane  ; nerves  and 
ganglia  well  developed,  as  usual  in  these  cases. 

Internally,  the  diaphragm  was  pushed  very  high  into  the 
thorax,  the  lungs  being  imperfectly  developed.  Pericardium 
mostly  wanting,  so  that  the  heart  and  lungs  laid,  as  it  were,  in 
one  common  cavity ; the  heart  being  well  formed.  The  me- 
sentery, also,  was  quite  imperfect,  appearing  more  or  less  per- 
forated and  tattered,  although  much  of  it  was  entire.  A fissure 
was  found  through  the  centre  of  the  uvula,  and  extending 
somewhat  into  the  soft  palate,  the  bones  being  separated,  as 
already  shown.  (Esophagus  quite  short.  The  stomach,  which, 
with  a portion  of  the  intestine,  has  been  injected  (No.  782,) 
was,  perhaps,  sufficiently  large,  but  of  a very  irregular  form  ; 


260 


MONSTROSITIES. 


the  right  extremity  terminating  in  a cul  de  sac,  and  the  intes- 
tine arising  at  a considerable  distance  from  it.  The  liver  was 
considerably  fissured,  and  the  umbilical  vein  entered  upon  the 
convex  face ; gall-bladder  and  ducts  apparently  vrell,  but 
the  intestine,  wherever  examined,  contained  only  a light 
colored,  pasty  mucus,  and  without  a trace  of  bile.  Renal 
capsules  exceedingly  small.  The  kidneys  were  united  by  their 
lower  extremities,  across  the  spine,  the  two  pelves  being  proved, 
by  inflation,  to  be  separate.  The  other  organs  w'ere  well 
formed.  Dr.  Anson  Hooker , of  East  Cambridge. 

782.  Malformed  stomach,  from  the  above  case. 

783-88.  In  the  four  next  cases,  constituting  the  third  variety 
of  the  “Acephalous  Foetus,”  the  spine  is  open  throughout, and 
much  incurvated,  as  in  the  last  group.  The  brain,  however, 
is  considerably  developed,  and  the  form  of  the  cranium  is 
much  altered,  in  regard  to  the  existence  of  the  parietal  bones,  and 
a consequent  change  in  the  posterior  portion  of  the  occiput. 

783.  Cranium  and  trunk  prepared,  and  mounted.  This  is  the  first 
specimen  in  the  present  series,  and  has  been  represented  in 
Figures  10  and  11.  The  head  being  thrown  very  far  back- 
wards, and  the  upper  half  of  the  spine  much  bent  upon  itself, 
the  posterior  portion  of  the  occipital  bone  is  closely  connected 
with  the  wings  of  the  ninth,  tenth,  and  eleventh  dorsal  verte- 
brae ; this  portion  of  the  occiput  consists  of  two  broad,  flat- 
tened bones  (a.  a.),  wanting  the  prolongation  which  usually 
extends  forwards  to  the  frontal,  as  the  parietals  (b.  b.)  exist  in 
this  case  ; these  last,  however,  are  in  a very  undeveloped  state. 
The  basilar  portion  of  the  occiput  is  large,  as  also  the  lateral 
portions  ; the  right  being  fused  with  the  temporal  bone.  The 
petrous  portion  of  the  temporals  is  very  irregular,  the  cranium 
being  otherwise  formed  as  usual  in  these  cases.  The  cervical, 
and  upper  half  of  the  dorsal  vertebrae,  are  bent  strongly  back- 
wards (Figure  11;)  the  lower  dorsal  forwards;  and,  below 
these,  the  spine  is  straight,  there  being  the  usual  number  of 
vertebrae,  unless  one  may  be  wanting  in  the  neck.  The  bodies 
of  the  cervical  consist  mainly  of  two  broad  lateral  portions  ; 
the  two  upper  dorsal  are  irregular  and  fused ; the  fifth  is  very 


MONSTROSITIES. 


261 


imperfect,  but  all  of  the  other  bodies  are  well  developed. 
The  wings  of  the  cervical  are  mostly  fused  ; the  seven  or  eight 
upper  dorsal  are  small  and  crowded,  although  distinct,  and  the 
rest  are  fully  developed.  The  ribs  are  normal,  except  for  a 
partial  fusion  of  the  tenth  and  eleventh,  upon  the  right  side. 
Extremities  well  formed,  and  have  been  removed  in  the  pre- 
paration. 

The  foetus  weighed,  when  recent,  three  pounds  and  six 
ounces  (avoird.)  and  was  quite  fat;  neck  most  completely 
wanting,  in  consequence  of  the  curvature  of  the  spine.  A 
mass  of  brain  existed,  equal  to  more  than  an  inch  in  diameter, 
and  at  its  base  were  several  nerves.  The  spinal  marrow  ex- 
isted, although  less  developed  than  in  the  next  case.  The  pa- 
rietes  of  the  abdomen  were  deficient  about  the  umbilicus,  and 
a tumor,  from  which  the  cord  arose,  was  formed  there,  two 
inches  in  extent,  and  covered  by  a transparent  membrane. 
The  liver  was  large,  and  sent  off  a considerable  lobe  between 
the  two  others,  to  form  the  protrusion  at  the  umbilicus.  The 
heart  was  malformed,  and  has  been  already  described  (No. 
341.)  Each  of  the  lungs  consisted  of  a single  lobe,  which 
was  deeply  fissured  at  the  base.  There  was  also  fissure  of  the 
uvula.  Renal  capsules  exceedingly  small ; right  hypogastric 
artery  wanting.  The  other  organs  were  well  formed,  as  were 
the  extremities. 

Labor  came  on  at  eight  and  a half  months ; the  child  pre- 
sented by  the  feet,  and  was  still  born  ; sex  female  ; quantity 
of  liquor  amnii  very  large.  The  mother  was  a respectable 
woman,  and  attributed  the  monstrosity  to  a fright  which  she  had 
received  when  six  weeks  pregnant ; had  had  three  other  child- 
ren, and  all  well  formed.  1845. 

Dr.  Milton  Fuller , of  Medford. 

784.  Cranium  and  trunk  prepared,  and  mounted.  This  is  the  second 
specimen  of  the  present  series,  and  is  represented  in  Figure 
12.  The  spine  is  so  strongly  bent  upon  itself,  as  to  bring  the 
occipital  bone  in  close  connection  with  the  two  last  dorsal  ver- 
tebrae. The  parietal  bones  (a.  a.)  are  developed  very  much 
as  in  No.  787,  and  extend  transversely  across  the  base  of  the 
cranium,  upon  which  they  are  depressed,  and  with  which,  to  a 
certain  extent,  they  come  in  contact,  the  right  being  rather  the 


262 


MONSTROSITIES. 


largest ; their  external  surface  is  quite  concave,  and  the  suture 
between  them  runs  obliquely  towards  the  right  side.  The  pos- 
terior portions  of  the  occipital  bone  ( b . b.)  are  connected  with 
the  parietals,  and  pretty  well  developed,  so  as  nearly  to  meet 
from  the  two  sides;  superior  edge  quite  dentated,  the  inferior 
being  thicker  and  smooth  ; on  the  right  side  it  is  fused  with  the 
lateral  portion,  and  with  the  temporal  bone.  The  frontal  bones 
(c.  c.)  are  considerably  developed,  but  strongly  depressed  upon 
the  base  of  the  cranium.  The  bodies  of  the  vertebrae,  in  the 
cervical  portion,  consist  of  five  or  six  pieces  irregularly  devel- 
oped ; two  or  three  of  the  upper  dorsal  are  also  irregular,  as 
well  as  the  sixth,  but  the  rest  are  sufficiently  well.  The  cer- 
vical wings  are  imperfect,  and  mostly  fused  ; those  on  the  right 
side  forming  one  mass  with  the  first  six  dorsal ; the  six  upper 
dorsal,  on  the  left  side,  are  also  fused,  but  not  with  the  cervi- 
cal ; otherwise  the  wings  are  well  developed.  On  the  left  side 
there  are  eleven  ribs,  which  are  not  remarkable  except  for  a 
fusion,  to  a small  extent,  between  the  fourth  and  fifth  ; on  the 
right  side,  there  are  twelve,  but  they  are  pretty  extensively 
fused. 

The  subject  of  this  case  was  a first  child,  and  bom  of  re- 
spectable parents.  Labor  came  on  in  the  night,  at  the  seventh 
month ; and  the  child  was  born  half  an  hour  before  Dr.  D.  ar- 
rived ; quantity  of  liquor  amnii  large.  The  heart  was  seen  to 
beat  about  thirty  times  in  a minute,  for  nearly  two  hours  after 
the  birth,  but  without  any  other  sign  of  life.  Sex  female. 

A mass  of  brain  was  found,  equal  to  §ij,  or  more,  and  divided 
upon  the  median  line,  almost  equally ; the  right  lobe  being 
again  subdivided ; something  like  a ventricle  was  also  found 
upon  the  left  side,  and  at  the  base  were  several  nerves. 

The  spinal  marrow  appeared  as  a thin,  flattened  ribband  of 
distinct  medullary  substance,  of  a reddish  color,  and,  as  ob- 
served in  some  other  cases,  divided  into  two  lateral  portions. 

The  parietes  of  the  trunk  were  extensively  deficient ; the 
liver,  stomach  and  intestines,  spleen,  heart,  and  left  lung  pro- 
truding. The  placenta,  which  was  born  with  the  child,  was 
not  remarkable.  The  cord  was  but  five  inches  in  length,  and 
sent  off  a duplicature  of  the  amnion,  from  half  an  inch  to  one 
inch  in  width,  which  was  expanded  over  the  organs,  and  could 
be  stripped  up  nearly  to  the  surrounding  integument.  Other- 


MONSTROSITIES. 


263 


wise  the  foetus  was  well  formed  externally,  except  for  a varus 
of  the  left  foot. 

On  dissection,  a thin,  dense,  fibro-cellular  membrane  was 
found  to  invest  the  protruded  organs,  when  the  amnion  was 
raised,  the  muscles,  of  course,  being  wanting.  The  heart  was 
fully  and  regularly  developed,  some  elongation  only  being  ob- 
served of  the  vessels,  which  were  put  upon  the  stretch  by  the 
unnatural  position  of  the  organ ; pericardium  well.  In  the 
right  cavity  of  the  thorax  there  was  nothing  very  remarkable. 
Upon  the  left  side  there  was  no  pleural  cavity,  and  nothing  in 
place  of  the  lung  but  a coarse  cellular  tissue  ; the  lung  itself 
appeared  just  beneath  the  transparent  membranes,  not  unlike  a 
thin  muscular  expansion,  the  bronchus  being  small  in  propor- 
tion to  the  undeveloped  condition  of  the  organ.  The  liver  was 
somewhat  irregularly  developed ; ascending  colon  situated 
in  the  middle  of  the  abdomen,  as  in  the  earlier  months ; the 
renal  capsules  were  larger  than  usual  in  such  cases,  and  the 
left  hypogastric  artery  was  wanting,  the  organs  being  otherwise 
well  formed.  1845.  Dr.  Henry  Dyer. 

785.  A colored  drawing  of  a monstrosity,  an  account  of  which  was 
published  by  the  late  Dr.  Charles  T.  Hildreth,  in  the  Medical 
Magazine  for  July,  1834.  The  third  specimen  in  this  series 
(p.  254.)  This  drawing  was  made  by  a professed  artist,  and 
was  afterwards  engraved  on  copper,  and  published  with  the 
case  ; engravings  being  also  made  of  the  skeleton.  The  whole 
was  done  at  the  expense  of  Dr.  H.,  and,  the  plates  having 
been  preserved,  have  been  used  for  the  present  work.  The 
case  is  particularly  mentioned  by  St.  Hilaire  (Hist,  des  Anom. 
II.  313,)  and  the  drawing  of  the  monstrosity  has  been  repre- 
sented in  one  of  his  plates. 

The  external  appearances  of  the  foetus  are  so  well  repre- 
sented in  Figure  No.  13,  as  to  render  a general  description 
unnecessary.  The  weight  was  three  pounds  and  one  ounce, 
and  the  length  thirteen  inches.  Sex  female. 

The  brain  rested  upon  the  expanded  dorsal  and  lumbar  ver- 
tebrae, and  upon  the  integument  which  covered  the  depressed 
cranial  bones,  sending  a prolongation,  however,  beneath  these 
last.  After  dissection,  it  was  carefully  collected,  and  found  to 
weigh  three  ounces.  It  was  divided  into  two  equal  hemi- 


264 


MONSTROSITIES. 


spheres,  and  imperfectly  into  convolutions,  the  arachnoid 
membrane  being  continuous  about  the  base  with  the  common 
integument.  The  whole  mass  was  very  soft,  and  of  a dusky 
red  color,  from  congestion,  and  effused  blood  ; there  being  in 
each  hemisphere  a cavity  which  was  filled  with  coagula.  No 
other  parts  of  the  brain  were  recognized,  and  no  connection 
was  traced  between  this  mass  and  any  of  the  nerves,  either 
cerebral  or  spinal. 

The  spinal  marrow  was  wanting,  and,  the  spinal  column  be- 
ing open  throughout,  the  nerves  terminated,  as  usual,  in  the 
membrane  upon  its  posterior  face.  A very  small  bundle  of 
nervous  fibres  was  seen  passing  down  over  five  or  six  of  the 
processes  upon  the  left  side,  and  a few  of  the  cranial  nerves 
were  found,  among  which,  it  was  thought,  was  the  par  vagum. 
Nerves  of  the  trunk  and  extremities  well  developed. 

The  internal  organs  were  well  formed,  except  for  the  kid- 
neys ; these  were  united  across  the  spine  (No.  787,)  and  the 
left  was  not  more  than  half  as  large  as  the  right ; upon  the 
right  side  were  two  ureters,  which  were  distinct  throughout ; 
renal  capsules  sufficiently  developed.  There  was  also  but  one 
umbilical  artery.  The  development  of  the  renal  capsules  is 
interesting  as  an  exception  to  the  general  law,  and  it  should  be 
observed,  that,  in  the  last  case,  these  organs  were  larger  than 
usual  in  the  “ acephalous  foetus.” 

The  history  of  this  case  was  as  follows : The  mother  was 

a married  woman,  thirty-five  years  of  age,  of  excitable  tem- 
perament, and  had  previously  had  two  well  formed  children. 
In  the  present  case,  the  motions  of  the  child  were  not  felt  until 
about  the  end  of  the  fifth  month,  and  were  always  feeble  and 
peculiar.  The  uterine  tumor  was  uniformly  tense,  and,  towards 
the  end  of  the  seventh  month,  increased  very  rapidly,  so  as  to 
fill  the  epigastrium,  and  cause  a very  painful  distention.  De- 
cember 20th,  being  called  hastily,  in  the  night,  to  attend  a sick 
child,  she  felt  a remarkable  subsidence  of  the  tumor,  the 
change  in  her  form  being  very  apparent ; this  was  soon  fol- 
lowed by  paroxysms  of  pain  in  the  right  hip,  with  vomiting 
and  constipation,  which  continued  more  or  less  for  five  or  six 
days,  but  were  relieved  after  free  evacuations,  although  the 
sense  of  painful  distention  continued.  On  the  9th  of  January, 
whilst  walking  across  the  room,  she  had  a slight  uterine  pain. 


MONSTROSITIES. 


265 


and,  suddenly,  a most  profuse  discharge  of  liquor  amnii : slight 
pains  continued  through  the  day,  and  with  them  considerable 
discharges  of  water ; but,  in  a day  or  two,  she  was  about 
again,  and  much  more  comfortable  than  before ; slight  motions 
of  the  child  being  still  occasionally  felt.  On  the  15th  of  Jan- 
uary labor  came  on,  and  was  accomplished  with  very  little 
pain ; the  child  was  born  alive,  but  completely  enveloped  in 
the  membranes,  the  mother  having  felt  its  motions  for  fifteen 
or  twenty  minutes  after  it  was  expelled.  On  the  arrival  of  Dr. 
H.,  half  an  hour  afterwards,  the  lower  extremities  were  still  in 
the  vagina,  and,  from  its  position,  the  child  had  probably  de- 
scended with  the  face  to  the  pubes.  1834. 

Dr.  Charles  T.  Hildreth. 

786.  Skeleton  of  the  specimen  above  described,  and  of  which  a 
back  and  a side  view  are  represented  in  Figures  14  and  15. 
The  head  is  bent  strongly  backwards,  and  there  is  also  a lateral 
inclination  of  the  head  and  spine.  The  frontal  and  parietal 
bones  ( a . a.  and  h.  h.)  are  much  more  developed  than  in  any 
of  the  preceding  specimens,  but  are  depressed  towards  the 
base  of  the  cranium ; posteriorly,  or  rather  inferiorly,  how- 
ever, there  is  a broad,  open  cavity,  which  readily  admits  the 
ends  of  three  fingers.  The  basilar  and  lateral  portions  of  the 
occiput  are  sufficiently  developed,  but  the  basilar  has  a pecu- 
liar hexagonal  form,  and  the  lateral  portions  are  seen  to  en- 
croach much  upon  the  petrous  portion  of  the  temporal  bones. 
The  posterior  portion  of  the  occiput  consists  of  two  bones 
(c.  c.),  one  upon  each  side,  of  a somewhat  rhomboidal  form, 
and  tolerably  developed ; that  upon  the  right  side  is  curved 
upon  itself,  and  forms  a part  of  the  cranial  cavity,  a small 
portion  of  it  only,  above  the  curve,  being  seen  in  Figure  15; 
the  one  upon  the  opposite  side  is  rather  behind  or  below  the 
cavity,  but  they  both  serve  to  connect  the  parietal  bones  with 
the  spinous  processes  of  the  dorsal  vertebrae.  There  is  also 
another  distinct  bone,  which  is  marked  c.,  and  may  perhaps  be 
considered  as  a part  of  the  occiput ; it  is  a long  and  narrow 
bone,  situated  behind  the  right  parietal  and  posterior  occipital ; 
resting,  like  the  occiput,  upon  the  extremity  of  the  spinous 
processes  of  the  vertebrae,  and  forming,  with  the  left  parietal, 
the  posterior  edge  of  the  cranial  cavity.  The  other  bones  of 
34 


266 


MONSTROSITIES. 


the  head  are  not  particularly  remarkable  ; palatines  not  sepa- 
rated, as  in  some  of  the  cases. 

The  spinal  column,  as  before  stated,  is  open  throughout ; 
otherwise,  the  vertebrae  are  well  developed,  from  below  up- 
wards to  the  twelfth  dorsal.  Above  this,  the  bodies  are  well 
developed  as  high  as  the  sixth  dorsal,  above  which  they  be- 
come more  and  more  irregular.  The  dorsal  wings,  on  the 
right  side,  are  generally  well,  except  for  a fusion  of  the  first 
two ; upon  the  left  side,  the  last  six  are  sufficiently  well, 
although  less  regular  than  those  on  the  right,  but  above  these 
are  four  others  which  are  fused  and  much  compressed,  in  con- 
sequence of  the  curvature  of  the  spine  towards  that  side  ; upon 
the  ninth  is  a distinct  bone,  marked  k.  in  the  figure,  and 
which  appears  not  unlike  a rudimentary  wing ; something  of 
the  same  kind  having  been  observed  in  No.  780.  The  cervi- 
cal vertebrae  are  very  irregular ; the  bodies  consist,  for  the 
most  part,  of  two  lateral  rows  of  small  bones ; the  first  pair  of 
wings  are  small  and  distinct,  but  below  these  are  four  others 
which  are  fused  together,  and  with  the  dorsal,  those  upon  the 
left  side  being  shown  (Z.)  in  Figure  14. 

The  ribs  upon  the  right  side  are  of  the  usual  number,  and 
fully  developed ; the  second,  third,  and  fourth,  however,  are 
fused  at  their  angles,  and  the  eleventh  becomes  very  broad 
near  its  anterior  extremity,  as  seen  in  the  figure.  On  the  left 
side,  the  twelfth  only  is  normal ; the  first  is  quite  small,  and 
between  this  and  the  next  is  a large,  open  space,  the  ribs  be- 
low this  being  much  compressed,  fused,  and  irregularly  de- 
veloped ; as  to  the  number,  there  may  be  one  or  two  wanting, 
but  this  is  doubtful.  The  pelvis  and  extremities  are  well  de- 
veloped. 

787.  Kidneys  and  renal  capsules  from  the  above  case  (p.  264.) 

788.  Head  and  trunk  of  the  fourth  and  last  specimen  in  this  series 
(p.  254)  ; the  deformity  is  excessive,  as  is  shown  in  Figure 
No.  16.  The  occipital  bones  are  united  with  the  spinous  pro- 
cesses as  far  down  as  the  first  lumbar  vertebra,  except  upon 
the  left  side,  where  there  is  a deficiency  to  a considerable  ex- 
tent between  the  lateral  portion  of  the  occiput  and  the  spine  ; 
the  antero-posterior  curvature  of  the  spine  is  very  strong,  the 


MONSTROSITIES. 


267 


upper  dorsal  and  the  middle  lumbar  vertebrae  forming  the 
prominent  points,  and,  as  a consequence,  the  pelvis  and  the 
anterior  extremities  of  the  ribs  are  brought  into  close  contact. 
The  cranial  cavity  is  quite  capacious.  The  frontal  bones  (a.) 
are  fully  as  large  as  in  the  last  specimen,  and  the  parietals  (J.) 
are  considerably  larger  and  convex  outwardly,  there  being  a 
considerable  space  between  the  frontals  and  the  base  of  the 
skull.  The  basilar  and  lateral  portions  of  the  occiput  are  well 
developed  ; the  posterior  portion  ( c .)  consists  upon  each  side  of 
one  piece,  the  one  upon  the  left  being  more  rectangular,  but 
the  one  upon  the  opposite  side  sending  out  a long  and  slender 
portion  which  is  connected,  as  in  the  preceding  cases,  with  the 
parietal  bone,  and  forms  the  posterior  boundary  of  the  cranial 
cavity.  Orbital  cavities  deep,  as  a consequence  of  the  devel- 
opment of  the  frontal  bones  ; upper  maxillaries  not  co-ossified  ; 
the  palatine  fossa  being  deep  and  narrow,  and  the  palatine 
bones  themselves  small. 

The  spinal  column  has  some  lateral  distortion,  besides  the 
strong  curvature  above  reported  ; the  wings  of  the  first  cervi- 
cal vertebra  separate  ; otherwise,  the  wings  of  all  of  the  cer- 
vical vertebras,  of  which  there  are  six  or  seven,  and  of  the 
first  seven  dorsal,  upon  the  left  side,  are  co-ossified,  except  for 
two  linear  divisions  ; upon  the  right  side,  the  cervical  and  first 
dorsal  wings,  and  below  these  two  or  three  others  are  co-os- 
sified, the  wings  of  the  other  vertebrae  being  separate.  An 
additional  wing  is  seen,  resting  upon  the  wings  of  the  second 
and  third  lumbar  vertebrae  upon  the  left  side,  and,  upon  the 
same  side,  the  wings  of  two  or  three  of  the  upper  sacral  ver- 
tebrae have  produced  a growth  of  bone,  which  extends,  as  one 
continuous  piece,  to  about  the  median  line,  and  forms,  thus  far, 
something  like  a spinal  canal.  There  is  also  seen  a very 
anomalous  bone,  larger  and  thicker  than  the  wing  of  a verte- 
bra, besides  differing  from  one  in  form ; it  is  attached  at  one 
extremity,  by  fibrous  substance,  to  the  back  of  the  first  lumbar 
vertebra,  and  at  the  other,  to  the  inner  surface  of  the  posterior 
portion  of  the  occipital  bone,  upon  the  right  side,  thus  forming 
an  arch  over  a portion  of  the  spinal  column.  The  cervical 
portion  of  the  spine  is  of  considerable  length,  broad  and  flat- 
tened. Some  obliquity  of  coccyx,  but  pelvis  otherwise  well. 

Thorax  exceedingly  prominent.  The  sternum  is  fully  de- 


268 


MONSTROSITIES. 


veloped,  but  the  anterior  half  has  no  connection  with  the  ribs, 
and  appears  perfectly  naked.  Upon  the  right  side  there  are 
seven  ribs ; the  cartilage  of  the  first  joins  the  sternum  about 
midway ; the  second,  third,  and  fourth  are  fused  posteriorly, 
and  the  cartilage  of  the  second  is  to  a certain  extent  wanting  ; 
the  fifth,  sixth  and  seventh  are  also  fused  posteriorly,  and, 
instead  of  terminating  as  usual,  send  out  a broad,  thin,  but 
strong  expansion  of  bone,  which  stretches,  like  a diaphragm, 
across  the  front  of  the  spine,  and  even  to  some  distance  beyond 
it  upon  the  left  side,  where  it  is  connected  again  with  the  body 
of  the  vertebra,  and  appears  as  one  of  the  ribs.  The  above 
remarkable  appearance  has  been  represented  in  Figure  17. 
Upon  the  left  side,  there  are  twelve  ribs,  including  the  one 
which  is  fused  with,  or  which  is  sent  off  from  those  upon  the 
opposite  side,  this  being  the  tenth  in  order ; the  first  two  are 
disconnected  with  the  sternum,  as  in  birds ; a rudimentary 
cartilage,  however,  being  sent  off  as  if  to  meet  the  second ; 
the  first  is  very  small ; from  the  third  to  the  eighth,  inclusive, 
the  ribs  are  well  developed  ; the  ninth  and  eleventh  are  broad 
and  flattened  ; the  eleventh  having  a slender  attachment,  which 
connects  it,  near  its  head,  with  the  front  of  the  body  of  the 
vertebra,  midway ; the  twelfth  is  normal. 

The  extremities,  being  well  formed,  except  for  the  club- 
feet, have  been  removed. 

Externally,  this  foetus  was  quite  fleshy,  and  would  probably 
have  weighed  four  or  five  pounds.  Deformity  very  great,  the 
neck  being  absolutely  wanting,  and  the  upper  extremities  ap- 
parently much  elongated ; circumference  about  thorax  four- 
teen inches  ; both  feet  affected  with  varus,  as  so  often  happens 
where  the  nervous  centres  are  imperfectly  developed.  The 
frontal  and  parietal  bones  evidently  existed,  but  were  much 
depressed,  and  covered  by  scalp  and  hair ; the  brain  appeared, 
with  a quantity  of  deep  red  vascular  tissue,  and  formed  a mass 
about  the  size  of  an  English  walnut,  the  deficiency  of  the 
spine  appearing  below.  About  this  deficiency,  was  an  appear- 
ance of  cicatrization,  the  cuticle  being  continued,  to  some  ex- 
tent, beyond  the  limits  of  the  cutis ; this  appearance  is  usually 
seen,  to  a greater  or  less  extent,  and  the  cuticle  has  often  been 
separated  from  the  subjacent  parts  by  maceration. 

On  dissection,  a mass  of  brain  was  removed  from  the  era- 


MONSTROSITIES. 


269 


nial  cavity,  equal  in  bulk,  by  estimate,  to  giijss. ; convolutions 
distinct ; one  portion  was  firmer  than  the  rest,  and  showed 
some  appearance  of  a pons,  and  medulla  oblongata.  Upon 
the  bodies  of  the  lumbar,  and  a few  of  the  dorsal  vertebrae, 
there  were  seen  two  large  parallel  nervous  cords,  which  be- 
came united  at  the  lower  extremity,  and,  upon  raising  up  the 
brain,  there  was  seen  beneath  it  a thin  expansion  of  medullary 
substance,  which  was  probably  connected  with  the  cords  just 
mentioned  ; nerves  and  ganglia  distinct,  as  usual. 

In  the  roof  of  the  mouth  there  was  the  very  deceptive  ap- 
pearance, which  is  so  often  seen  in  these  cases,  as  of  a fissure 
through  the  palate  ; the  uvula,  however,  was  divided  upon  the 
median  line  ; thymus  gland  quite  large  ; lungs  irregularly  fis- 
sured ; alimentary  canal  well,  except  that  the  ccecum  and  as- 
cending colon  were  found  in  the  middle  of  the  abdomen  ; liver 
large,  and  irregularly  divided. 

The  kidneys  were  in  the  usual  situation,  and  separate,  but 
rather  small,  and  seemed  to  be  made  up  of  thin  and  delicate 
cysts,  apparently  containing  a thin  liquid,  and  being  about  a 
line  in  diameter  (No.  789.)  The  right  ureter  was  of  some 
size  and  firmness,  from  the  bladder  upwards,  to  about  the  brim 
of  the  pelvis ; bnd  the  left  ureter  was  in  the  same  condition, 
nearly  to  the  kidneys ; they  then  became  abruptly  so  small 
and  filiform,  that  they  could  scarcely  be  traced,  and  continued 
without  any  further  change  as  far  as  the  kidneys.  Bladder 
small.  The  renal  capsules  were  as  large,  in  proportion  to  the 
size  of  the  kidneys,  as  in  a well  formed  foetus,  but  were 
broadly  and  intimately  united  across  the  spine,  like  a horse- 
shoe kidney  (No.  789.)  The  same  condition  was  found  in 
No.  762.  St.  Hilaire  (I.  543)  quotes  a case  of  fusion  of  the 
testicles,  kidneys,  and  renal  capsules,  and  remarks  that  there 
is  no  other  case  of  this  last  on  record.  The  other  organs  were 
well  formed. 

This  case  occurred  in  the  practice  of  Dr.  S.  W.  Drew. 
The  mother  was  a respectable  woman,  and  this  was  her  first 
child.  When  about  two  and  a half  months  pregnant,  she  at- 
tended an  operation  upon  the  eye,  when  she  became  very  faint 
and  remained  so  for  some  time.  Labor  occurred  at  eight  and 
a half  months,  and  was  short ; liquor  amnii  discharged  before 
Dr.  D.  arrived,  but  nothing  was  said  of  the  amount ; head  pre- 


270 


MONSTROSITIES. 


sented,  and  the  child  lived  about  half  an  hour.  Sex  female. 
1847. 

789-95.  The  four  next  cases  may  be  grouped  together  as  a fourth 
and  last  variety  of  the  “Acephalus  Foetus.”  The  spine  is  en- 
tire, except  in  the  first,  in  which  the  deficiency  may  be  con- 
sidered as  an  accidental  complication ; the  cranial  cavity  is 
■ closed  posteriorly  by  the  occiput,  and  the  parietals  exist,  but 
there  is  very  little  appearance  of  brain,  and  the  same  was  ob- 
served in  a similar  case,  which  was  dissected  some  years  since. 
Superiorly,  the  cranial  cavity  is,  of  course,  open,  and,  in  most 
of  the  cases,  largely  so. 

789.  An  entire  skeleton,  being  the  first  specimen  in  this  series. 
The  posterior  portion  of  the  occiput  consists  of  a single  piece, 
that  extends  from  side  to  side,  and  rises  perpendicularly  from 
the  spine,  the  upper  edge  being  thick,  smooth,  and  rounded, 
and  the  lower  edge  deeply  notched  upon  the  median  line.  As 
a rudimentary  parietal,  there  is,  upon  the  right  side,  a long, 
narrow,  flattened  bone,  reaching  from  the  frontal  to  the  occip- 
ital, and  depressed  upon  the  base  of  the  skull,  there  being 
nothing  of  the  kind  upon  the  other  side.  The  frontal  bones 
are  not  much  more  developed  than  in  the  first  variety  of  this 
form  of  monstrosity.  Otherwise,  the  cranium  is  not  remarka- 
ble, except  for  the  vertical  direction  of  the  base  of  the  skull 
posteriorly. 

The  spine  is  perfect  in  its  cervical  portion,  but  below  this  it 
is  open  throughout.  The  wings  of  the  two  last  dorsal,  and  first 
lumbar  vertebrae  are  fused,  and  the  body  of  the  tenth  dorsal  is 
imperfect,  so  as  to  cause  a considerable  lateral  curvature. 
From  the  bodies  of  the  second  and  third  lumbar  vertebrae,  pos- 
teriorly, there  arises  a mass  of  bone,  apparently  formed  by  the 
fusion  of  three  or  four  rudimentary  wings,  uniting  with  the 
proper  wings  upon  the  left  side,  and  forming  the  passage  for  a 
large  nerve  that  went  to  the  sciatic.  Sacrum  very  imperfect ; 
three  distinct  wings  upon  the  right  side,  and  two  on  the  left, 
these  last  being  fused  ; at  its  lower  extremity,  anteriorly,  is  an 
anomalous  bone,  about  one  line  in  diameter,  and  extending 
transversely  from  side  to  side.  Coccyx  entirely  wanting. 

The  pelvis  is  well  formed,  in  itself,  but  the  antero-posterior 


MONSTROSITIES. 


271 


diameter  is  much  elongated,  and  it  seems  to  be  attached  to  the 
front  of  the  sacrum  rather  than  to  the  sides.  Ribs  well  formed, 
and  of  the  usual  number,  except  upon  the  left  side,  where  the 
last  two  are  wanting,  and  the  tenth  becomes  abruptly  widened, 
about  midway,  as  in  Figure  15. 

Externally,  this  foetus  was  well  formed,  except  for  the 
head  and  back ; neck  not  shortened,  and  the  ears  inclined  but 
little  forwards.  Weight  two  pounds  and  two  ounces.  Upon 
the  base  of  the  skull  was  a prominent,  irregular,  lobulated 
mass  of  pia  mater,  equal  to  an  inch  or  more  in  diameter,  and 
containing  a few  serous  cysts,  but  no  trace  of  brain.  The 
spinal  marrow  was  somewhat  enlarged  just  at  its  termination, 
and  gave  origin  to  the  portio  dura  and  mollis,  and  to  the  par 
vagum  ; the  fifth  pair  of  nerves,  with  its  Casserian  ganglion, 
and  the  spinal  accessory  were  also  distinct.  In  the  neck,  the 
spinal  marrow  seemed  to  be  perfectly  developed,  but  below 
this,  it  was  altogether  wanting ; a cavity,  however,  was  found, 
as  usual,  on  cutting  through  the  membranes,  and  the  nerves 
were  seen  going  off  upon  each  side,  one  large  branch  passing 
through  the  adventitious  passage  in  the  lumbar  region,  as  above 
stated.  Internal  organs  well  formed,  except  for  the  small  size 
of  the  renal  capsules  (No.  792,)  and  a small  diverticulum  from 
the  intestine  (No.  791.) 

The  mother  was  a young  married  woman,  and  this  was  her 
first  child.  Labor  natural ; head  presented ; quantity  of  liquor 
amnii  very  great.  The  child  gasped  for  about  five  hours  after 
it  was  born,  and  bled  freely  from  the  head  and  back,  but 
showed  no  other  signs  of  life.  Sex  male.  1838. 

Dr.  George  Hayward. 

790.  Two  drawings  of  the  above  specimen,  as  it  appeared  in  the 
recent  state  ; a back  and  side  view.  Dr.  Jeffries  Wyman. 

791.  A diverticulum,  from  the  above  case. 

792.  Kidney  and  renal  capsule,  from  the  same. 

793.  A mounted  cranium,  represented  in  Figure  18,  and  forming 
the  second  specimen  in  this  series.  The  posterior  portion  of 
the  occipital  bone  (a.)  consists  of  a single,  thick,  solid  piece  of 


272 


MONSTROSITIES. 


bone,  extending  across  from  side  to  side,  and  rising  perpen- 
dicularly from  the  spine,  the  upper  edge  being  smooth,  round- 
ed, and  almost  eburnated  ; it  is  firmly  anchylosed  to  the  lateral 
portions,  and,  in  part,  apparently,  to  the  temporal  bones.  The 
frontal  and  parietal  bones  ( i . and  c.)  are  very  considerably  de- 
veloped, but  depressed  entirely  down  upon  the  base  of  the  cra- 
nium ; upper  surface  of  the  parietals  concave.  The  opening 
in  the  vault  of  the  cranium,  formed  by  the  occipital  and  two 
parietal  bones,  is  not  far  from  the  size  and  form  of  the  thumb- 
nail ; posteriorly,  the  whole  base  of  the  cranium  is  inclined 
upon  the  portion  that  is  anterior  to  it,  so  as  to  come  into  a ver- 
tical position,  the  basilar  and  posterior  portions  of  the  occiput 
being  parallel  to  each  other,  as  remarked  by  St.  Hilaire 
(II.  322,)  in  a form  of  monstrosity,  which,  in  some  respects, 
resembled  the  present  case  ; this  appearance  was  observed  in 
three  cases,  at  least,  of  the  present  series. 

The  foetus  was  sent  to  Dr.  C.  from  the  country.  It  lived 
nine  hours  after  it  was  born,  and  weighed  seven  pounds  and  a 
half.  Sex  female. 

In  the  recent  state,  the  top  of  the  cranium  was  flattened 
from  the  orbits  backwards,  but  was  covered  by  integument 
and  brain,  except  towards  the  back  part,  where  it  was  deficient 
to  the  extent  of  two-thirds  of  an  inch  or  more.  From  this 
part,  there  projected  or  hung  off  two  or  three  soft,  dark  red 
masses,  having  a serous  surface,  one  being  about  as  large  as 
the  top  of  the  finger,  and  the  others  much  smaller,  the  integu- 
ment stopping  abruptly  about  their  base.  Just  behind  the 
large  mass  there  was  seen  a small  opening  which  led  in  the 
direction  of  the  spinal  cavity,  but  this  was  not  traced.  On 
cutting  through  these  masses,  they  were  found  to  consist  of  a 
dark  red,  flaccid,  oedematous,  apparently  cellular  tissue,  con- 
taining a serous  cyst,  about  the  size  of  a pea,  but  no  trace  of 
brain ; on  removing  this  tissue,  however,  from  between  the 
vault  and  base  of  the  cranium,  a small  mass  of  cerebral  sub- 
stance was  found,  and  which  was  apparently  in  the  situation  of 
the  pituitary  gland.  The  spinal  marrow  terminated  in  an  ex- 
pansion in  the  membranes,  between  the  basilar  and  posterior 
portions  of  the  occipital  bone,  the  nerves  being  sent  off  on  each 
side.  Otherwise  the  foetus  was  well  formed,  externally  and 
internally,  except  for  the  small  size  of  the  renal  capsules. 
1842.  Dr.  Walter  Channing. 


MONSTROSITIES. 


273 


794.  The  cranial  bones,  in  this  specimen,  have  been  separated  by 
maceration,  mounted  separately  upon  pedestals,  and  placed  in 
a small  glass  case  ; the  third  in  the  present  series. 

The  posterior  portion  of  the  occipital  bone  is  seen  to  con- 
sist of  two  broad  pieces,  which  are  deficient,  so  as  in  the  re- 
cent state  to  greatly  enlarge  the  foramen  magnum,  although 
superiorly  they  nearly  met.  The  upper  edge  of  these  two 
bones  is  thin,  rough,  and  inclined  forwards ; the  surface  pos- 
teriorly is  somewhat  convex,  and  they  are  strongly  anchylosed 
both  with  the  lateral  portions  of  the  occiput  and  with  the  tem- 
poral bones ; differing  much,  then,  from  the  last  two  speci- 
mens. The  lateral  portions  are  distinguished  by  their  outward 
direction,  and  large  foramina  ; and  the  basilar,  by  its  unusual 
breadth. 

The  frontal  bones  are  very  considerably  developed,  as  in  the 
last  case,  and  partially  anchylosed,  the  orbital  and  frontal  por- 
tions being  almost  compressed  into  one  broad  flat  piece.  The 
parietals  consist,  as  in  the  same  specimen,  of  two,  broad,  flat, 
irregular  bones,  which  were  depressed  so  as  nearly  to  touch 
the  base  of  the  cranium ; upper  face  concave.  Large  wings 
of  the  sphenoid  bone  co-ossified  with  the  body,  and  very  im- 
perfectly and  irregularly  developed ; foramina  large  ; body 
large,  and  terminates,  in  front  of  the  small  wings,  in  a strong 
point.  The  squamous  portion  of  the  temporal  bones  is  larger 
than  in  the  first  form  of  the  “ acephalous  foetus”  (p.  249,)  and 
the  carotid  foramen  is  long  and  circuitous,  but  otherwise,  there 
is  no  marked  difference  ; ring  large,  irregular,  and  co-ossified. 
The  lower  maxillary  bone  is  rather  short,  but  stout ; posteri- 
' orly,  it  is  broad  and  flaring  ; anteriorly,  it  is  pointed,  and  the 
two  portions  are  strongly  co-ossified.  There  is  one  anomalous 
bone,  of  a triangular  form,  and  equal  to  about  five  lines  in  ex- 
tent, but  this  was  not  seen  until  after  the  bones  had  been  sepa- 
rated by  maceration.  St.  Hilaire  remarks  (II.  302)  upon  the 
very  compact  and  almost  eburnated  condition  of  many  of  the 
bones,  and  especially  of  the  occipital,  in  a certain  form  of 
monstrosity,  to  which,  osteologically,  the  present  specimen  and 
the  last  seem  to  be  allied,  and  in  both  of  which,  this  structure, 
in  nearly  all  of  the  larger  bones,  is  strongly  marked.  The 
form  of  monstrosity  referred  to,  however,  is  characterized, 
according  to  St.  Hilaire,  by  a pedunculated  brain,  resting  upon 
35 


274 


MONSTROSITIES. 


the  depressed  vault  of  the  cranium,  apparently  somewhat  de- 
veloped, and  covered,  for  the  most  part,  by  integument;  whereas, 
in  these  two  cases,  the  quantity  of  cerebral  substance  was  very 
small,  and  it  was  covered  only  by  serous  membrane.  The 
cervical  vertebrae  have  been  preserved,  the  wings  being  irregu- 
larly developed,  and  somewhat  fused  ; the  two  upper  ribs  of 
each  side  are  also  seen  to  be  fused. 

The  subject  of  this  case,  which  occurred  in  the  practice  of 
the  late  Dr.  Henry  G.  Wiley,  was  an  illegitimate  child ; and 
this  was  the  only  instance  of  the  kind  that  was  observed  in  all 
of  the  cases  of  “ acephalous  foetus”  that  are  here  referred  to, 
so  far  as  was  ascertained.  With  regard  to  another  point,  the 
mother  was  said  to  have  carried  her  child  ten  months ; and  St. 
Hilaire  refers  to  a similar  occurrence  in  a form  of  monstrosity 
to  which  the  present  case  is  nearly  allied  (II.  346.)  Weight 
nearly  six  pounds.  Sex  female.  Top  of  head  quite  flat,  even 
with  the  brows,  and  covered  by  integument,  on  which  was  some 
hair.  On  the  back  part,  and  about  over  the  occipital  foramen, 
was  a dark  red  mass,  covered  by  serous  membrane,  about  one 
inch  and  a quarter  in  diameter,  and  consisting  partly  of  cere- 
bral substance.  All  of  the  joints  of  the  lower  extremities 
were  more  or  less  distorted,  and  also  the  hands  ; the  fingers 
being  strongly  flexed,  and  the  points  bent  permanently  back- 
wards. Internal  organs  well  formed,  except  for  the  small  size 
of  the  renal  capsules,  and  for  the  existence  of  two  ureters 
upon  the  left  side.  1842. 

795.  A mounted  cranium ; the  fourth  and  last  case  in  this  series. 
The  frontal  bones  are  not  much  more  developed  than  in  No. 
789,  and  are  more  irregular  than  in  any  other  specimen.  The 
parietals,  also,  are  represented  by  two  very  irregular  little 
bones,  from  three  to  four  lines  in  length,  and  situated  behind 
the  frontals.  The  posterior  portion  of  the  occipital  bone  con- 
sists of  two  broad  pieces,  which  meet  upon  the  median  line, 
and  slightly  overlap,  except  inferiorly,  where  there  is  some  de- 
ficiency ; upper  edge  arched  forwards,  as  in  the  last  case,  and 
somewhat  eburnated ; not  co-ossified  with  the  lateral  portions, 
nor  with  the  temporal  bones ; the  basilar  portion  is  almost 
parallel  with  the  posterior,  as  above  stated  (p.  272.) 

The  mastoid  portion  of  the  temporal  bone  is  imperfectly  de- 


MONSTROSITIES. 


275 


veloped,  and  the  three  pieces  of  the  sphenoid  are  co-ossified, 
as  are  also  the  two  superior  maxillary  bones.  The  spine  was 
entire  throughout,  and  the  skeleton  was  otherwise  well 
formed. 

The  child,  in  this  case,  was  fully  developed,  and  would 
probably  have  weighed  seven  pounds.  Born  at  the  full  period, 
before  Dr.  W.’s  arrival,  and  lived  ten  hours.  Sex  male.  The 
mother  had  had  several  well  formed  children,  and  attributed 
the  malformation,  in  the  present  case,  to  a very  direct  and 
strong  moral  impression,  the  explanation  being  given  since  her 
delivery.  The  tumor  upon  the  top  of  the  head  was  about  the 
size  of  an  English  walnut,  and  somewhat  flattened,  the  arach- 
noid being  apparently  covered  by  a very  delicate  membrane, 
which  resembled  the  cuticle,  as  seen  about  the  base  of  the  tu- 
mor, and  when  detached  by  putrefaction.  The  tumor  con- 
sisted almost  entirely  of  serous  cysts,  from  two  to  six  lines  in 
diameter,  and  connected,  as  usual,  by  a greatly  congested  cel- 
lulo-vascular  tissue,  and  at  the  base  there  was  some  appear- 
ance of  an  arachnoid  cavity.  One  mass  of  rather  doubtful 
cerebral  substance  was  found,  about  flve  lines  in  diameter,  and 
two  and  a half  lines  in  thickness,  of  a greyish  color,  ecchy- 
mosed,  and  having  almost  the  consistence  of  a lymphatic 
gland.  The  spinal  marrow  terminated  just  above  the  foramen 
magnum,  in  a broad,  thin  expansion.  Internally,  the  renal 
capsules  were  quite  small,  the  kidneys  large,  and  each  of  the 
ureters  formed  two  separate  ducts  for  some  distance  after 
leaving  the  organs  ; in  the  uvula  there  was  also  the  trace  of  a 
division  along  the  median  line.  Otherwise,  the  organs  were 
well  formed,  the  thymus  gland  appearing  rather  large,  as  it 
often  does.  In  the  stomach  were  six  or  eight  distinct  ulcera- 
tions, from  half  a line  to  a line  in  diameter,  and  with  some  ap- 
pearances of  inflammation ; this  being  the  only  case  in  which 
anything  like  acute  disease  was  found  in  the  internal  organs. 
1845.  Dr.  Abner  B.  Wheeler. 

796.  Spina  bifida  ; a wet  preparation.  The  malformation  reached, 
externally,  from  the  sacral  into  the  dorsal  region,  and 
measured  three  inches  and  one-fourth.  Integuments  immedi- 
ately about  it  cicatrized,  as  in  the  “ acephalous  foetus.”  Sur- 
face at  first  rather  depressed,  but  before  death  considerably 


276 


MONSTROSITIES. 


elevated  by  the  effusion  which  took  place  ; it  was  also  excori- 
ated from  the  time  of  birth,  and  discharged  a thin,  purulent 
matter.  On  cutting  through  the  membranes,  the  cavity  be- 
neath was  found  in  a state  of  intense  inflammation,  as  shown 
by  the  effusion  of  serum,  and  a large  quantity  of  recent 
lymph.  This  last  being  removed,  the  spinal  marrow  was  seen 
terminating,  as  usual  in  these  cases,  where  the  malformation 
commenced,  and  adhering  to  the  inner  surface  of  the  cavity ; 
below  this,  the  nerves  went  off  from  the  membranes  upon  each 
side ; the  anterior  and  posterior  branches,  and  the  ganglia 
connected  with  these  last,  being  perfectly  distinct,  and  of  full 
size,  as  shown  in  the  preparation.  Upon  each  side  there  was 
another  cavity,  which  was  apparently  distinct  from  the  first,  but 
in  the  same  state  of  inflammation. 

The  subject  of  this  case  was  a twin-child,  and  otherwise 
well  formed,  except  for  a strong  eversion  of  the  right  foot ; the 
other  child  was  well  formed,  but  had  died,  apparently,  before 
labor  began ; both  were  males.  Frequent  and  ineffectual  at- 
tempts were  made  to  induce  motion  in  the  lower  extremities ; 
urine  and  faeces  discharged  about  once  in  two  days,  and  it  was 
never  observed  to  make  any  expulsive  effort.  Much  distressed 
on  the  first  night,  but  was  afterwards  kept  constantly  under  the 
influence  of  paregoric,  and  it  died,  without  any  material 
change  of  symptoms,  on  the  tenth  day. 

Inflammation  of  the  membranes,  as  a cause  of  death  in 
these  cases,  is  described  and  figured  by  Cruveilhier  (Anat. 
Path.),  and  the  same  has  been  several  times  observed  here. 
In  one  case,  the  lymph  not  merely  invested  the  whole  spinal 
marrow,  and  extended  to  the  base  of  the  brain,  but  the  brain 
itself  was  completely  and  very  peculiarly  disorganized ; and, 
throughout  the  spinal  marrow,  there  was  the  appearance  of 
a central  canal,  which  was  filled  with  thick  yellow  pus.  1839. 

Dr.  James  B.  Gregerson. 

797.  A dry  preparation,  to  shov.  die  condition  of  the  bones,  in  a 
case  of  spina  bifida.  The  wings  of  the  last  three  lumbar  ver- 
tebrae, as  well  as  the  sacral,  are  separated  from  each  other, 
though,  individually,  they  are  seen  to  be  fully  developed. 
When  recent,  there  existed,  at  this  part,  a soft,  red  tumor,  two 
inches  in  diameter,  the  edges  projecting  over  the  base ; this 


MONSTROSITIES. 


277 


ruptured  probably  at  the  time  of  birth,  and,  so  long  as  the  child 
lived,  discharged  abundantly,  the  surface  having,  to  some  ex- 
tent, an  opaque,  and  somewhat  sloughing  appearance.  In- 
ternally, the  sac  was  highly  inflamed,  as  in  the  last  case,  and, 
above  this,  there  was  an  imperfect  cavity  in  which  the  spinal 
marrow  was  seen  to  terminate,  the  nerves  being  connected,  as 
usual,  with  the  membranes. 

This  was  also  a male  child ; otherwise  well  formed,  and 
lived  about  two  weeks.  Had  a perfect  use  of  the  lower  ex- 
tremities, and  seemed  to  be  doing  well  until  the  eighth  day, 
when  there  came  on  convulsions  of  the  head  and  upper  ex- 
tremities, which  recurred  very  frequently,  and  were  constantly 
becoming  worse  as  long  as  it  lived.  The  lower  extremities 
were  not  convulsed,  but,  when  the  change  occurred,  became 
paralyzed,  and  there  was  some  rigid  contraction  of  the  muscles 
of  the  feet  and  toes,  the  system  generally  becoming  affected. 

Dr.  Z.  B.  Adams. 

798.  A second  specimen,  similar  to  the  last.  The  subject  of  this 
case  was  a first  child,  and  hydrocephalic ; presented  by  the 
feet,  and  was  still-born.  Sex  female.  Labor  occurred  at 
eight,  or  eight  and  a half  months ; quantity  of  liquor  amnii 
very  large.  The  head  was  eighteen  inches  in  circumference, 
and  the  ventricles  of  the  brain  were  large  in  proportion ; cra- 
nial bones  widely  separated,  with  some  perforations  through 
their  substance. 

The  preparation  shows  an  open  condition  of  the  spinal  ca- 
nal, from  the  eighth  dorsal  vertebra  downwards,  the  bodies  and 
wings  of  the  vertebrae  being  in  no  way  remarkable,  except  for 
a fusion  of  the  wings  of  the  seventh  and  eighth  upon  the  right 
side.  In  the  recent  state,  the  corresponding  part  of  the  sur- 
face of  the  back  presented  the  usual  appearance,  being  de- 
pressed rather  than  otherwise  ; membranes  thickened  towards 
the  median  line,  and  gave  origin,  as  it  were,  to  the  nerves, 
both  branches  of  which,  with  their  ganglia,  were  of  full  size  ; 
no  distinct  appearance  of  medullary  substance  ; cavity  not 
inflamed.  1847.  Dr.  Stephen  Ball. 

799.  Spina  bifida  in  a boy,  sixteen  years  of  age  ; the  spinal  mar- 
row terminating  at  the  fourth  dorsal  vertebra ; the  spine  was 


278 


MONSTROSITIES. 


removed  as  low  down  as  the  sacrum,  and  has  been  prepared  to 
show  the  condition  of  the  bones.  At  birth,  there  was  observed 
a small  tumor  in  the  middle  of  the  back,  the  surface  having 
much  the  appearance  of  an  old  cicatrix,  and  below  this,  in  the 
lumbar  region,  was  an  “ ulcer”  about  half  as  large  as  the 
hand  ; paralysis  complete  below  the  ribs.  Nursed  as  well  as 
any  child,  and  appeared  to  enjoy  perfect  health,  the  “ ulcer  ” 
discharging  for  about  six  months,  and  then  healing  entirely. 
Generally  quite  costive,  and  the  feces  were  passed  involun- 
tarily. Urine  also  discharged  involuntarily  ; always  perfectly 
limpid,  without  sediment  or  odor,  and,  until  a short  time  before 
death,  much  more  copious  than  natural ; the  character  of  the 
excretion  being  very  different  from  what  is  generally  observed 
in  cases  of  paraplegia.  Appetite  generally  good,  and  he  was 
not  troubled  with  indigestion.  When  he  was  between  thirteen 
and  fourteen  years  old,  hair  appeared  upon  the  pubes,  but  he 
never  showed  any  sexual  propensities,  so  far  as  could  be  ascer- 
tained. The  tumor,  in  the  middle  of  the  back,  was  exceed- 
ingly tender,  but  in  the  ulcer  there  never  appeared  to  be  the 
least  sensibility,  not  even  on  the  application  of  caustics.  Right 
leg  often  oedematous,  but  the  left  never ; both  were  always  of 
a natural  temperature,  and  not  liable  to  become  cold.  Mind 
active ; upper  half  of  the  body  unaffected.  About  two  years 
before  his  death,  the  ulcer  in  the  lumbar  region  broke  out 
again,  and  he  gradually  sank  under  the  profuse  discharge 
which  took  place  from  the  surface. 

On  dissection,  the  surface  of  the  tumor  over  the  middle  of 
the  back  appeared  as  if  cicatrized  ; beneath  this  was  a coarse, 
white,  cellular  tissue,  which  contained  no  fat,  like  the  sur- 
rounding integuments,  and  beneath  this  a serous  cavity,  formed 
by  the  expansion  of  the  spinal  membranes,  and  partly  filled 
with  serum.  The  wings  of  the  dorsal  vertebra;,  from  the 
fourth  to  the  ninth,  inclusive,  were  separated  so  that,  midway, 
the  little  finger  could  be  passed  freely  about  within  the  cavity, 
at  the  upper  extremity  of  which  the  spinal  marrow  was  dis- 
tinctly felt  to  terminate  in  the  membranes  posteriorly,  as  usual 
in  spina  bifida,  and  from  this  point  downwards  it  was  satisfac- 
torily ascertained  that  the  spinal  marrow  did  not  exist.  Below 
this  fissure  the  spinal  canal  was  again  completed  by  the  union 
of  the  wings  of  the  two  next  vertebrae,  those  of  the  last  dorsal 


MONSTROSITIES. 


279 


and  first  lumbar  being  also  closely  approximated.  The  four 
last  lumbar  and  first  sacral  were  open  posteriorly,  the  wings 
upon  the  right  side  being  very  imperfectly  developed,  and 
partly  fused,  whilst  those  on  the  left  side  could  hardly  be  said 
to  exist ; the  foramina  for  the  nerves,  however,  were  sufficiently 
large.  Throughout  the  lumbar  region  there  was  found,  in  the 
situation  of  the  spinal  cavity,  a coarse,  white,  cellular  tissue, 
surrounded,  for  the  most  part,  by  a firm  membrane,  which  ap- 
peared to  be  an  extension  of  the  dura  mater,  and  upon  this 
last,  the  nerves  appeared  to  terminate.  The  wings  of  the 
dorsal  vertebra),  from  the  third  downwards,  were  extensively 
fused,  the  last  being  also  very  irregular ; bodies  of  the  fifth, 
seventh  and  eighth  formed  throughout  in  two  lateral  portions. 
The  spine,  at  the  dorsal  region,  was  strongly  bent  towards  the 
right  side,  the  bodies  of  the  vertebrae  at  that  part  being  nar- 
rower on  that  side  than  on  the  other.  There  was  also  a dis- 
ease of  the  first  two  lumbar  vertebrae,  about  one-half  of  the 
bodies  of  these  bones  having  been  destroyed  by  caries,  with 
their  intervertebral  substance  ; some  new  bone  was  thrown  out 
upon  them  anteriorly,  and  a very  considerable  quantity  of  the 
same  upon  most  of  the  rudimentary  wings  of  the  lumbar  ver- 
tebrae upon  the  left  side,  this  new  bone  lying  immediately  be- 
neath the  ulcerated  surface,  so  as  to  be  covered  by  little  more 
than  the  granulations. 

The  thoracic  and  abdominal  organs  appeared  sufficiently 
healthy  ; the  liver  was  rather  large  and  of  a pale  fawn  color, 
but  the  lungs  were  not  tuberculous.  1836. 

Dr.  Asa  B.  Snow. 

800.  Cast  in  plaster  of  the  nates  and  lower  part  of  the  back,  show- 
ing the  size  and  form  of  the  tumor,  in  a case  of  spina  bifida, 
which  may  be  compared  with  the  following  dissected  specimen. 
The  patient  is  a bright,  healthy-looking  little  girl,  four  years  of 
age ; walked  as  early  as  other  children,  and  is  disposed  to 
play,  but  soon  becomes  tired,  and  often  falls,  the  lower  extrem- 
ities being  turned  much  inwards,  and  deficient,  to  a certain 
extent,  in  the  power  of  motion  ; the  urine  and  faeces  are  often 
discharged  involuntarily,  the  bowels  being  always  costive. 
The  tumor  is  of  a regular  rounded  form,  like  a female  breast, 
about  as  large  as  the  fist,  and  situated  over  the  very  lower  part 


280 


MONSTROSITIES. 


of  the  spine  ; it  is  perfectly  covered  by  cutis  and  integument, 
and  resembles  to  the  feel,  not  an  encysted,  but  rather  a com- 
mon fatty  tumor,  so  that  excision  has  often  been  suggested ; 
upon  the  surface  there  is  nothing  remarkable,  excepting  a mi- 
nute, warty-looking  body,  and  some  appearance,  as  of  a small 
nsevus  ; the  separation  of  the  wings  of  the  sacrum  is  not  dis- 
tinctly felt.  The  tumor,  which  was  small  at  the  time  of  birth, 
has  grown  rather  faster  in  proportion  than  the  child  itself. 
January  27th,  1845.  Dr.  Charles  E.  Ware. 

801.  A specimen  which  is  preserved  in  spirit,  and  shows  the  con- 
dition of  the  parts  in  a case  similar  to  the  last.  The  tumor 
was  rather  towards  the  left  side,  about  three  inches  in  diame- 
ter, fleshy  to  the  feel,  and  covered  by  integument,  with  a small 
nsevus  upon  the  surface,  as  in  the  other  case.  On  dissection, 
it  was  found  to  consist  mainly  of  fat,  but  near  the  surface  was 
a cavity  of  some  size,  formed  by  an  expansion  of  the  spinal 
membranes,  and  in  which  the  spinal  marrow  itself  terminated, 
about  half  an  inch  within  the  sac.  The  wings  of  the  sacral 
vertebra  are  separated,  excepting  perhaps  the  first,  and  upon 
the  left  side  two  or  three  are  fused  into  a separate  mass  of 
considerable  size,  and  are  connected  with  the  ilium  and  ischi- 
um. The  bodies  of  the  same  vertebrse  are  also  irregularly 
developed,  and  upon  the  left  side  there  is  quite  a deficiency  of 
bone,  leaving  a circumscribed  cavity,  at  the  bottom  of  which 
the  theca  is  seen,  and  the  nerves  arising,  as  it  were,  from  it. 

The  patient  was  a male  child,  fourteen  months  old,  always 
feeble,  and  subject  to  diarrhoea,  under  which  it  at  last  sank, 
October  10th,  1843.  The  power  of  motion  in  tire  lower  ex- 
tremities was  imperfect,  so  that  it  could  never  stand  alone,  and 
there  was  a want  of  control  of  the  sphincters  of  the  rectum 
and  bladder.  The  tumor  was  congenital,  and  grew  with  the 
child,  and  the  case  was  particularly  interesting  in  connection 
with  the  one  last  described,  as  the  two  patients  lived  for  a time 
in  the  same  neighborhood,  and  were  observed  together. 

Dr.  Henry  G.  Wiley. 

802.  The  trunk  and  lower  extremities  of  a malformed,  seven 
months  fcetus.  When  recent,  a large,  rounded,  uniform,  en- 
cysted tumor  was  situated  over  the  sacrum,  and  apparently 


MONSTROSITIES. 


281 


just  ready  to  burst ; it  was  formed  by  common  integument, 
and  so  far  differed  from  the  ordinary  cases  of  spina  bifida.  On 
being  laid  open,  it  was  found  to  contain  §x  of  serum,  though 
far  from  being  distended,  and  was  lined  by  a smooth,  polished, 
and  highly  vascular  membrane.  Through  an  opening,  one- 
fourth  of  an  inch  in  diameter,  there  protruded  a small  portion 
of  spinal  marrow,  which  adhered  to  the  inner  surface  of  the 
sac,  and  may  still  be  seen  in  the  preparation ; this  continuatioq 
of  the  spinal  marrow  in  substance  into  the  lower  part  of  the 
canal,  and  below  where  the  cauda  equina  usually  forms,  has 
been  observed  in  certain  cases  of  spina  bifida  since  the  time  of 
Morgagni.  The  external  organs  of  generation  and  the  anus 
were  wanting.  Both  feet  turned  inwards,  and  the  left  also  up- 
wards. Otherwise,  the  foetus  was  well  formed  externally.  On 
examination  of  the  internal  organs,  the  uterus  was  found  to  be 
of  some  size,  but  the  cavity  terminated  below  in  a cul  de  sac, 
and  the  vagina  was  wanting ; left  Fallopian  tube  and  ovary 
normal.  The  right  Fallopian  tube  and  ovary,  also,  seemed  to  be 
well  developed,  but  the  tube,  instead  of  uniting  with  the  uterus, 
took  the  course  of  the  round  ligament,  and  was  lost  towards 
the  groin.  The  kidneys  were  entirely  wanting,  but  the  renal 
capsules  were  of  full  size,  and  in  their  proper  place  ; so,  in  a 
specimen  that  was  exhibited  to  the  Society  by  Dr.  Samuel 
Parkman,  one  of  the  kidneys  was  wanting,  but  the  renal  cap- 
sules were  equally  and  fully  developed  ; and  in  a case  that  was 
observed  by  Dr.  Lewis,  at  his  dissecting-room,  the  left  kidney 
was  situated  in  the  cavity  of  the  pelvis,  but  the  renal  capsule 
was  in  its  usual  place.  The  bladder,  of  course,  was  very 
small,  but  communicated  with  the  rectum  by  a capillary  open- 
ing, as  in  the  cases  of  imperforate  anus,  above  described 
(p.  129.)  All  of  the  above  points,  excepting  the  last,  are 
shown  in  the  preparation ; the  rectum  is  also  seen,  much  dis- 
tended, the  rest  of  the  intestine  being  cut  away.  Gall-bladder 
wanting,  the  ducts  being  traced  directly  from  the  liver  into  the 
intestine.  The  liver  itself,  and  the  other  abdominal  organs  were 
well  formed,  and  have  been  removed.  In  the  thorax  there 
was  nothing  remarkable  excepting  a deep  yellow  stain  upon 
the  external  surface  of  the  ventricles  of  the  heart ; this  was 
another  instance  of  kirronosis,  of  which  so  marked  a case  has 
already  been  recorded  (No.  744.)  1836. 

36  Dr.  D.  H.  Storer. 


282 


MONSTROSITIES. 


803.  A mounted  cranium,  in  which  there  is  seen,  near  the  centre 
of  the  posterior  portion  of  the  occipital  bone,  an  oval,  defined 
opening,  about  two  lines  in  diameter,  and  extending  quite 
through  the  bone ; there  is  also  a considerable  deficiency  of 
the  frontal  bones,  commencing  at  the  anterior  fontanelle,  and 
terminating  rather  abruptly  some  way  above  the  orbits.  The 
subject  was  a female  child,  born  rather  prematurely,  and  lived 
but  a few  hours.  Upon  the  back  of  the  head  was  a soft  tu- 
mor, about  the  size  of  a large  filbert,  sufficiently  defined,  but 
flattened,  and  covered  by  healthy  integument ; on  incision, 
there  was  found  a small  cavity  within,  lined  by  a delicate,  vas- 
cular, serous  membrane,  which  seemed  to  penetrate  the  open- 
ing in  the  occiput,  and  to  be  connected  within  the  cranium, 
but  this  last  point  was  not  examined.  Otherwise,  the  child 
was  well  formed  externally  and  internally.  1846. 

Dr.  John  Homans. 

804.  A mounted  cranium,  showing  a deficiency  in  the  occiput,  and 
upper  part  of  the  spine.  The  child  was  born  with  a cyst  at- 
tached to  the  back  of  the  head,  covered  by  integument,  and 
nearly  as  large  as  the  head  itself.  The  cyst  presented  in  the 
delivery,  and,  as  it  caused  some  delay,  it  was  burst,  and  dis- 
charged a considerable  quantity  of  bloody  serum.  Labor  oc- 
curred at  six  and  a half  months,  and  the  child  lived  four  days 
and  a half.  During  this  time  it  appeared  very  feeble,  and 
only  one  attempt  was  made  to  give  it  nourishment,  this  causing 
much  distress  ; there  were  frequent  but  slight  convulsions  from 
the  time  of  birth,  and,  towards  the  last,  the  hands  were  strongly 
and  rigidly  flexed.  The  cyst  contracted  much  in  size  after  the 
child  was  born,  and  became  dark  and  quite  offensive. 

On  dissection,  the  inner  surface  of  the  cyst  appeared  to  be 
lined  by  a serous  membrane,  and  was  of  a dark  red  color. 
Through  the  deficiency  in  the  occiput,  which  was  at  once  ob- 
served, the  brain  protruded  somewhat,  and  was  covered  by  its 
proper  membranes,  and  by  the  dura  mater,  and,  having  been 
carefully  removed,  it  seemed  pretty  certain  that  the  cerebellum 
was  wanting,  and  the  pons  Varolii  very  imperfectly  developed. 
The  organs  of  the  thorax  and  abdomen  were  well  formed. 
Sex  male. 

The  cranium  is  generally  well  formed,  but  some  of  the 


MONSTROSITIES. 


283 


bones  are  imperfectly  developed.  The  anterior  fontanelle  is 
large,  the  frontal  bones  considerably  separated,  and  in  several 
places  the  bone  is  very  thin,  or  even  not  yet  formed.  This  is 
more  remarkable  along  the  upper  and  back  part  of  the  parie- 
tals,  and  also  along  their  inferior  border,  large  and  irregular 
deficiencies  in  the  bone  being  there  supplied  by  membrane  ; 
towards  the  vertex,  and  along  the  sutures,  the  fibres,  which 
shoot  out  from  the  edge  of  the  bone,  are  very  marked,  but 
about  the  membranous  patches  the  edges  of  the  bone  are  de- 
fined. The  place  of  the  bone  is  also  supplied  by  membrane, 
upon  each  side,  between  the  temporal  and  the  occipital  bones, 
and  also  at  the  base  of  the  skull,  between  the  petrous  portion 
of  the  temporal  and  the  sphenoid.  The  deficiency  in  the  oc- 
cipital bone,  above  referred  to,  enlarges,  as  it  were,  the  fora- 
men magnum,  measuring  three-fourths  of  an  inch  transversely, 
and  an  inch  and  two-thirds  antero-posteriorly,  from  the  junc- 
tion of  the  basilar  with  the  spine,  the  opening  posteriorly  being 
well  defined,  and  of  a regular,  oval  form.  The  separation  of 
the  lateral  portions  of  the  occiput  is  just  equal  to  the  width  of 
the  deficiency  in  the  posterior,  so  that  the  regular  form  of  the 
opening  is  preserved.  Otherwise,  the  cranium  is  well  formed. 
Several  of  the  cervical  vertebrae  having  been  prepared,  in 
connection  with  the  cranium,  the  wings  of  three  or  four  of 
them  are  seen  to  be  separated  so  as  to  enlarge  the  opening  in 
the  occiput,  and  there  is  one  wing  more  upon  the  right  side 
than  on  the  left,  causing  a lateral  inclination  which  was  as 
marked  in  the  recent  state  as  it  is  now ; most  of  the  bodies 
also  are  imperfectly  or  irregularly  developed.  1846. 

Dr.  Z.  B.  Adams. 

805.  A mounted  cranium,  in  which  the  upper  back  part  of  the 
skull  is  largely  open  and  greatly  malformed.  The  posterior 
portion  of  the  occiput  consists  of  two  parts,  one  behind  the 
other,  and  there  is  a second  large  foramen,  with  several,  small, 
irregular  bones  about  it,  which  suggest  the  idea  of  a second 
occipital  bone.  Otherwise,  the  cranium  is  well  formed,  except 
that  the  vault  is  altogether  larger  than  usual. 

When  recent,  there  existed  upon  the  back  of  the  head  a 
very  large  tumor,  formed  by  a protrusion  of  the  scalp,  and 
lined  by  dura  mater.  Otherwise,  the  foetus,  externally,  was 


284 


MONSTROSITIES. 


well  formed.  Sex  female.  In  consequence  of  the  great  size 
of  the  head,  an  extensive  rupture  of  the  uterus  took  place, 
and  the  patient  died  in  the  course  of  the  day.  After  the  oc- 
currence of  the  accident,  the  child  was  turned,  and  the  lower 
extremities  and  body  came  away  readily,  but  the  head  re- 
mained fixed  in  the  pelvis  until  it  was  perforated  through  the 
frontal  bone,  after  which  there  was  a copious  discharge 
of  water,  and  it  was  at  once  born.  1843. 

Dr.  J.  C.  Hayden. 

806.  A fostal  cranium,  showing  the  effects  of  hydrocephalus,  and 
the  condition  of  the  bones  in  fissure  of  the  palate.  It  is  much 
enlarged,  measuring  seven  inches  in  length,  and  four  inches 
and  one-fourth  between  the  parietal  protuberances  ; the  sagittal 
suture  varies  in  width  from  two  inches  to  two  and  three-fourths, 
and  the  whole  posterior  portion  of  the  cranium  is  largely  open. 
Between  the  frontal  bones,  anteriorly,  are  several  ossa  Wormi- 
iana,  two  of  which  are  quite  large  ; none  being  found  about 
the  occiput.  The  nasal  bones  are  one  inch  apart,  and  directed 
upwards  and  outwards.  The  left  superior  maxillary  bone  is 
imperfectly  developed,  and  contains  the  rudiments  of  the  ca- 
nine and  two  bicuspid  teeth  only  ; it  is  widely  separated  from 
the  vomer,  which  last  is  quite  broad,  and  altogether  larger  than 
usual.  The  right  superior  maxillary  is  well  developed,  except 
in  its  palatine  portion,  there  being  a deficiency  from  behind 
forwards  nearly  to  the  alveoli ; the  separation  from  the  vomer, 
however,  is  much  less  than  upon  the  other  side.  The  distance 
between  the  palatine  bones  is  ten  and  a half  lines.  Con- 
nected with  the  right  superior  maxillary  is  a portion  of  alveo- 
lus, or  intermaxillary  bone,  which  contains  the  first  incisor 
tooth  of  the  left  side. 

The  brain  was  tolerably  developed,  and  some  appearance 
of  convolutions  was  seen,  but  it  was  not  in  a state  for  any  fur- 
ther examination.  Internally,  the  organs  were  well  formed. 
Externally,  and  before  dissection,  the  fissure  in  the  lip,  upon 
the  left  side,  and  the  double  fissure  in  the  palate  corresponded 
with  the  condition  of  the  bones,  the  cavity  of  the  left  nostril 
and  that  of  the  mouth  being  directly  continuous,  and  the  left 
ala  nasi  being  carried  apparently  off  into  the  middle  of  the 
cheek,  so  that,  at  first  sight,  the  nose  upon  this  side  seemed  to 
be  wanting.  Otherwise,  the  foetus  was  well  formed. 


MONSTROSITIES. 


285 


Labor  came  on  at  the  end  of  the  eighth  month,  and  was  tei'- 
minated  in  twenty-four  hours.  The  membranes  ruptured  quite 
early,  as  Dr.  D.  supposed  at  the  time,  and  there  was  at  once  a 
discharge  of  water,  which  he  estimated  at  two  quarts,  after 
which  the  pains  subsided  for  some  hours.  The  child,  when 
born,  had  an  extensive  laceration  in  the  posterior  part  of  the 
scalp,  and  a direct  communication  with  the  cavity  of  the  cra- 
nium, but  the  scalp  itself  appeared  to  be  well  developed,  and 
perfectly  sound  in  structure.  1844.  Dr.  Horace  Dupee. 

807.  A highly  finished  and  very  correct  drawing,  by  Dr.  James  F. 
Colman  ; showing  the  external  appearances  of  a monstrosity 
which  was  presented  to  the  Society  by  Dr.  H.  B.  C.  Greene. 
The  foetus  weighed  eight  pounds  and  two  ounces,  and,  from  its 
size,  the  labor  was  very  difficult.  The  most  conspicuous  ob- 
ject was  a cyst,  which  arose  from  the  top  of  the  head,  rather 
to  one  side,  and  was  more  than  half  as  large  as  the  head  itself ; 
consisted  mainly  of  integument,  and  seemed  to  be  connected 
with  the  membranes  of  the  brain,  having  burst  during  labor, 
and  discharged  one  or  two  pints  of  fluid.  The  convolutions  of 
the  brain  were  seen,  but  the  organ  was  not  examined.  The 
situation  of  the  eyes  was  marked  externally  by  a slight  linear 
depression,  the  orbits  being  filled  with  adipose  substance  ; there 
was,  however,  something  like  a membrane,  with  a black  sub- 
stance upon  it,  and  which  was  probably  the  choroid  coat ; no 
trace  of  optic  nerves.  The  nose  consisted  of  two  slightly  pro- 
jecting aim,  and  a small  intermediate  prominence  ; nasal  cavi- 
ties distinct,  but  terminated  posteriorly  in  a cul  de  sac.  About 
the  mouth,  there  was  a double  hare-lip,  the  appearance  of  a 
deep  fissure  of  the  palate,  as  above  noticed  (p.  269),  and  an 
adhesion  of  the  under  surface  of  the  tongue,  quite  to  the  tip. 
The  sex  was  apparently  female,  but,  on  separating  the  labia, 
which  were  large  and  well  developed,  there  was  found  nothing, 
except  the  opening  of  the  urethra  at  the  upper  part  of  the  fis- 
sure, to  show  that  they  were  anything  more  than  a simple  fold 
of  the  integuments.  At  the  umbilicus  there  was  a hernial 
protrusion  of  the  intestines,  and  otherwise  the  trunk  was  well 
formed. 

The  lower  extremities  (No.  810)  were  quite  short;  the  feet, 
however,  were  of  the  full  size,  but  extended  so  as  to  form  a 


286 


MONSTROSITIES. 


continuous  line  with  the  front  of  the  leg.  Each  foot  has  six 
perfect  toes.  On  dissection  of  one  of  these  extremities,  there 
were  found  six  metatarsal  bones,  three  of  them  resting  upon 
the  cuboid,  and  the  remainder  on  three  cuneiform  bones,  one 
of  which  last  was  supernumerary,  the  large  cuneiform  pro- 
jecting so  far  beyond  the  edge  of  the  foot  as  not  to  support  any 
one  of  the  metatarsal  bones.  The  bones  of  the  thigh  and  leg 
were  short,  but  broad  and  stout.  One  of  the  upper  extremi- 
ties (No.  810)  had  five  perfect  fingers,  besides  the  thumb,  but 
upon  the  other,  the  supernumerary  finger  arises  from  the  cu- 
bital edge  of  the  hand,  and  is  directed  backwards  towards  the 
fore-arm,  as  in  a case  quoted  by  St.  Hilaire  (I.  686.) 

On  dissection,  the  epiglottis  was  found  to  be  wanting,  except 
for  three  little  shreds  ; glottis  large  and  very  prominent ; vocal 
cords  wanting ; body  of  the  hyoid  bone  very  broad,  and  the 
thyroid  cartilage  malformed.  Thoracic  organs  well  developed. 
Stomach,  intestines,  liver  and  pancreas  well.  Spleen  very 
much  fissured  and  lobulated  (No.  812.)  Kidneys  very  large, 
and  much  altered  in  structure  (No.  811,)  the  renal  capsules 
being  as  small  as  in  the  “ acephalous  foetus.”  Testicles  and 
vasa  deferentia  well  formed,  these  last  opening  freely  into  two 
distinct  cavities,  that  were  situated  in  a body,  which  seemed  to 
partake  of  the  character  of  a prostate  gland,  of  the  vesiculae 
seminales,  and  perhaps  of  the  uterus ; these  cavities  opened 
upon  each  side  of  the  verumontanum,  like  the  vesiculse,  but 
differed  from  them  in  structure.  In  front  of  these,  but  still  in 
the  same  organ,  was  a third  cavity  of  considerable  size,  rough 
upon  the  inner  surface,  but  quite  different  in  structure,  as  it 
was  distinct  from  the  first  two,  and  opening  largely  upon  the 
top  of  the  verumontanum.  The  inner  surface  of  the  urinary 
bladder,  to  the  extent  of  about  half  an  inch,  had  a strongly 
marked  arborescent  appearance,  as  usual  in  the  cervix  uteri ; 
neck  large  ; urethra  pervious  throughout,  and  opened  as  above 
stated,  but  without  any  appearance  of  a penis  or  clitoris. 

808.  Cranium  of  the  specimen  above  described.  The  vault  is  en- 
tirely open,  as  represented  in  Figure  19,  the  bones  which  form 
the  sides  being  tolerably,  though  irregularly  developed,  and 
deeply  serrated  upon  their  edges.  Parietals  wanting.  The 
basilar  and  two  lateral  portions  of  the  occipital  bone  are  sufti- 


MONSTROSITIES. 


287 


ciently  well  formed ; the  posterior  portion  consists  of  two 
pieces,  that  are  distinct,  and,  for  the  most  part,  widely  sepa- 
rated, though  they  meet  to  a small  extent  superiorly.  Upon 
the  right  side,  and  connected  with  this  last  part  of  the  occiput, 
is  a small,  triangular  bone,  two  or  three  lines  in  diameter, 
which  would  perhaps  be  regarded  by  some  as  a rudimentary 
parietal,  and  upon  the  opposite  side  there  seems  to  have  been  a 
corresponding  one.  This  posterior  portion  of  the  occiput  is, 
moreover,  distinguished  by  a considerable  lateral  distortion. 
Temporal  bones  sufficiently  well,  the  passage  for  the  carotid 
forming  a deep  groove.  The  sphenoid  bone  is  sufficiently 
large,  but  very  irregularly  developed  ; the  small  wings  are 
separated  from  the  body  to  the  extent  of  two  or  three  lines, 
and  are  connected  with  the  orbital  portion  of  the  frontal  bone 
and  the  cethmoid  ; the  body  of  the  bone  being  connected  anteri- 
orly with  the  united  maxillaries ; large  wings  sufficiently  well 
developed.  The  superior  maxillary  bones  are  veiy  broad  an- 
teriorly, and  short  in  their  antero-posterior  diameter ; the  alve- 
oli being  for  the  most  part  veiy  large,  and  the  palatine  fossa 
deep  and  much  compressed ; posteriorly,  the  orbital  portion 
inclines  directly  backwards,  and  the  two  are  united  by  a broad 
suture  below  the  eethmoid  bone.  The  palatine  bones  are 
small,  and  unite  so  as  completely  to  close  the  posterior  nares. 
The  nasal  cavity  is  large,  broad,  directed  upwards,  and  termi- 
nates in  a cul  de  sac,  the  orbital  cavities  being  small,  irregu- 
larly developed,  and  opening  largely  into  the  cavity  of  the  cra- 
nium. The  eethmoid  seems  to  be  imperfectly  developed,  and 
the  vomer  is  probably  wanting.  The  inferior  maxillary  bone, 
as  shown  in  the  figure,  is  very  irregular,  and  without  any  ap- 
pearance of  an  angle  ; the  two  pieces  are  intimately  united, 
the  chin  is  much  elongated,  and  from  beneath  it  there  projects 
a large,  thick  spine,  for  the  insertion  of  muscles ; in  the  situa- 
tion of  the  angles  it  flares  off  on  each  side  in  a broad  spine, 
and,  upon  the  inside,  there  is  a strong  ridge  of  bone,  which 
terminates  in  a very  prominent  spine,  about  where  the  nerve 
enters ; the  coronoid  process  is  comparatively  small,  and  the 
alveoli  are  quite  large,  as  in  the  upper  maxillary  bones.  The 
other  cranial  bones  are  not  remarkable,  neither  were  those  of 
the  trunk.  1838.  Dr.  H.  B.  C.  Greene. 


283 


MONSTROSITIES. 


809.  The  two  upper  and  one  of  the  lower  extremities  of  the  speci- 
men last  described. 

810.  One  of  the  kidneys,  from  the  above  specimen;  length  two 
inches  and  ten-twelfths,  and  otherwise  large  in  proportion ; 
surface  unequal  and  irregular,  but  not  lobulated,  and  having 
nothing  like  an  external  tunic  that  can  be  raised.  The  other 
kidney,  which  perfectly  resembled  it  externally,  having  been 
cut  open  in  the  recent  state,  there  was  found  no  trace  of  cor- 
tical nor  tubular  portions,  except  for  two  very  small  and  doubt- 
ful mamillary  processes ; consisted  of  a close,  tough,  but  very 
flaccid  tissue,  and  contained  an  immense  number  of  small 
cysts,  from  half  a line  to  one  line  in  diameter.  These  cysts 
were  collapsed,  as  if  the  fluid,  if  they  ever  contained  any,  had 
been  absorbed  ; their  parietes  were  firm  and  moderately  thick, 
and  they  could  be  very  readily  detached  from  the  substance  in 
which  they  were  imbedded.  The  same  appearance  was  found 
in  the  kidneys  of  a patient  from  whom  a malformed  uterus 
(No.  652)  was  taken,  and  something  of  the  kind  also  in  No. 
788. 

811.  Spleen  from  the  above  case. 

812.  Skeleton  of  a monstrous  Calf.  The  animal  was  born  at 
Wrentham,  March  15th,  1839,  at  the  full  period,  and  was  re- 
ceived on  the  following  day  in  a perfectly  fresh  state.  It  was 
regarded  in  the  neighborhood  as  a “ calf  changed  into  a bull- 
dog,” and  the  supposed  resemblance,  as  well  as  the  fact  of 
the  malformation,  was  attributed  to  a particular  fright  which 
the  cow  had  received  during  the  early  months  of  gestation. 
The  head  was  full  and  rounded,  the  line  of  the  face  was  abrupt, 
the  muzzle  was  short  and  square,  and  the  under  lip  was  some- 
what projecting.  The  extremities  were  very  short,  but  of  full 
size,  and  this  was  one  of  the  most  remarkable  peculiarities  in 
the  case  ; the  anterior  being  turned  directly  backwards,  the 
posterior  backwards  and  inwards.  The  measurements  were, 
from  the  muzzle  to  the  root  of  the  tail  twenty-seven  inches, 
and  to  the  top  of  the  head  seven  inches  and  three-fourths ; cir- 
cumference of  body  twenty-six  inches ; extremities  six  inches 
in  length,  the  anterior  being  six  inches  and  three-fourths,  and 


MONSTROSITIES. 


289 


the  posterior  seven  inches  in  circumference.  On  dissection  of 
the  thorax  and  abdomen,  nothing  unusual  was  found. 

The  cranium  is  represented  in  Figure  20,  and  presents  the 
following  peculiarities,  as  compared  with  a standard  specimen 
of  about  the  same  age.  The  cranial  portion  is  sufficiently 
large,  but  quite  broad  and  rounded ; no  indications  of  hydro- 
cephalus, which,  according  to  St.  Hilaire,  (II.  212)  has  been 
so  often  observed  in  animals  affected  with  this  form  of  mon- 
strosity, the  bones  being  sufficiently  thick,  and  the  structure 
healthy.  The  sagittal  and  lambdoidal  sutures  exist,  but  with  a 
slight  deficiency  of  bone  at  their  junction.  The  superior  and 
lateral  portions  of  the  occiput  are  co-ossified,  as  also  the  basi- 
lar portion  and  the  sphenoid  bone.  Foramen  magnum  small 
and  irregular.  Basilar  portion  of  occiput  thick,  quite  irregular, 
and  with  a well  marked  longitudinal  fissure  upon  the  under 
surface.  The  facial  portion  of  the  skull  is  also  quite  broad, 
with  a flaring  of  the  upper  and  lower  jaws ; the  shortness, 
however,  is  the  most  striking  peculiarity,  the  distance  from  the 
posterior  extremity  of  the  vomer  to  the  extremity  of  the  inter- 
maxillary bones  being  three  inches  and  one-fourth,  whilst  in  the 
other  cranium,  which  could  have  been  very  little  older,  it  was 
five  inches  and  three-fourths.  A broad  fissure  in  the  palate  is 
also  observed,  not  involving  the  intermaxillary  bones,  but  ex- 
tending quite  through  the  maxillaries,  the  separation  between 
these  last  being  one  inch  and  two-thirds,  and  the  palatine  por- 
tion of  course  very  imperfectly  developed.  Orbits  large. 
Nasal  bones  short,  and  very  broad. 

The  trunk  is  separately  preserved,  and  also  the  individual 
extremities,  as  ligamentary  preparations ; the  first  is  well 
formed,  excepting  the  pelvis.  The  feet,  also,  with  the  carpus 
and  tarsus,  are  well  formed-,  but  the  other  parts  are  exceedingly 
imperfect ; the  scapulse,  humerus,  radius  and  ulna,  femur,  tibia 
and  fibula  consisting  of  very  short,  thick,  and  irregular  bones, 
measuring  generally  from  one  inch  and  a fourth  to  two  inches 
in  length.  Each  of  the  ossa  innominata  consisted  of  a single 
piece,  and  were  quite  as  imperfectly  developed  as  the  bones  of 
the  extremities,  the  cavity  of  the  pelvis  being  very  small. 
The  extremities  of  the  femur  and  humerus  were  formed  by 
very  large,  rounded,  cartilaginous  masses,  but  are  now,  of 
course,  quite  dried  up.  1839.  Dr.  J.  B.  S.  Jackson. 

37 


290 


MONSTROSITIES. 


813.  A drawing,  to  show  the  external  appearances  in  the  above 

case  ; by  Dr.  Jeffries  Wyman. 

814.  A fostal  skeleton,  showing  an  imperfect  development  of  the 

extremities,  &c.  The  subject  was  a male  child,  premature  and 
still-born.  It  was  quite  plump,  and  generally  well  developed, 
externally  and  internally ; the  hands  and  feet,  also,  as  in  the 
last  case,  were  of  full  size  and  well  formed,  but  the  limbs  were 
very  short,  and  the  bones  thick  and  stout.  Before  the  skeleton 
was  dried,  the  humerus  and  ulna  measured,  each,  one  inch 
and  a fourth  in  length,  and  the  hand  one  inch  and  a half ; the 
femur  one  inch  and  a fourth,  the  tibia  one  inch  and  a third, 
and  the  foot  nearly  two  inches  ; the  femur  being  considerably 
curved,  and  some  of  the  other  bones  more  or  less  so.  The 
cranium  is  generally  well  formed ; the  parietal  bones,  how- 
ever, are  deficient  on  each  side  of  the  vertex,  so  as  to  leave  a 
defined  opening,  which  measures  one  inch  and  three-fourths 
transversely,  and  one  inch  in  the  opposite  direction,  with  two 
ossa  Wormiana  at  the  posterior  fontanelle,  and  a third  about 
the  middle  of  the  sagittal  suture.  The  ribs  also  are  shorter 
than  usual.  The  spine  is  perfect,  and  measures  eight  inches 
in  length.  1846.  Dr.  John  Homans. 

815.  Cast  in  plaster  of  the  above  specimen. 

Dr.  William  E.  Coale. 

816.  Imperfectly  developed  extremities,  in  connection  with  hydro- 
cephalus, and  malformation  of  the  cranial  bones  (No.  817.) 
This  case  occurred  in  the  practice  of  Dr.  E.  T.  Learned,  of 
Weymouth ; the  child  presented  by  the  breech,  and  in  about 
an  hour  the  head  was  removed.  The  head  was  quite  large, 
and  discharged,  on  being  tapped,  about  five  or  six  ounces  of 
serum;  external  ears  malformed  and  very  imperfect ; lower 
jaw  also  very  imperfect,  and  evidently  disconnected  with  the 
base  of  the  skull. 

The  right  upper  extremity,  before  dissection,  consisted  of  an 
arm  and  hand  which  were  well  developed,  except  for  an  ab- 
sence of  the  thumb  ; the  hand,  however,  formed  a right  angle 
with  the  arm  ; the  fore-arm  is  wanting,  and  the  carpus  is  seen, 
in  the  preparation,  to  be  directly  attached  to  the  humerus. 


MONSTROSITIES. 


291 


The  left  upper  extremity  consisted  of  a hand  having  only  three 
fingers,  but  otherwise  well  developed ; seemed  to  be  attached 
almost  directly  to  the  shoulder ; a short  bone,  however,  could 
be  felt,  and  this,  on  dissection,  proved  to  be  an  imperfectly  de- 
veloped humerus.  The  right  lower  extremity  consisted  of  a 
foot,  having  four  toes,  but  otherwise  well  developed,  though 
arising  directly  from  the  groin ; on  dissection,  the  fourth  me- 
tatarsal bone  was  found  to  be  entirely  wanting,  except  for  its 
very  anterior  extremity  ; the  tarsus  was  developed  in  propor- 
tion to  the  number  of  toes.  The  left  lower  extremity  also 
arose  directly  from  the  groin,  was  an  inch  and  a quarter  in 
length,  consisted  of  a single,  well  developed  toe,  and  terminated 
posteriorly  in  a proper  heel,  the  bones  and  cartilages  being  de- 
veloped in  accordance  with  the  external  appearances.  The 
muscles,  nerves,  and  blood-vessels  were  not  examined.  In 
place  of  the  pelvic  bones,  there  are  seen  on  the  right  of  the 
sacrum  two  small  cartilages,  one  above  the  other,  and  upon 
the  left  side  a third,  which  is  still  smaller.  The  pelvis,  and  the 
right  upper  and  left  lower  extremities  are  preserved  together  in 
one  jar  in  spirit,  and  the  left  upper  and  right  lower  extremities 
are  preserved  in  a second  jar,  as  dry  specimens.  The  internal 
organs  were  well  formed,  and  the  spine  was  six  inches  and  a 
quarter  in  length.  Dr.  Winslow  Lewis. 

817.  Some  of  the  cranial  bones,  from  the  above  case,  mounted 

separately,  and  displayed  upon  a black-board.  The  lower  jaw 
consists  of  two  small  bones,  of  the  usual  width,  and  united  by 
a proper  symphisis,  but  developed  only  to  the  extent  of  the 
alveoli  for  the  incisor  and  canine  teeth.  The  two  upper  max- 
illary bones  are  united,  and  in  these  also  the  alveolar  portion 
is  very  deficient.  Between  the  petrous  portion  of  the  tempo- 
ral bone  and  the  body  of  the  sphenoid  is  a large,  thick,  and 
exceedingly  irregular  bone,  nearly  equal  in  extent  to  the  body 
and  wings  of  the  sphenoid ; upon  the  right  side  it  is  separate, 
but  upon  the  left  it  is  anchylosed  to  the  sphenoid  and  temporal 
bones.  1845.  Dr.  Winslow  Lewis. 

818.  A drawing,  in  India  ink,  of  Mr.  Benoni  T.  Bachelder,  who 
exhibited  himself  in  this  city  not  long  since,  and  an  account  of 
whose  case  was  published,  with  remarks,  by  Dr.  O.  W.  Holmes, 


292 


MONSTROSITIES. 


in  the  Boston  Med.  and  Surg.  Journal  (March  3d,  1847.)  Ac- 
cording to  Dr.  H.,  Mr.  B.  is  twenty-eight  years  of  age,  and  has 
one  perfect  extremity,  the  others  being  abortive  stumps,  and 
much  like  those  left  after  amputation. 

The  right  humerus  is  a foot  or  more  in  length.  The  deltoid 
and  pectoral  muscles  are  well  developed  ; the  biceps  has  a 
well  marked  fleshy  belly,  but  tapers  rapidly,  in  common  with 
the  other  muscles  of  the  arm,  towards  the  lower  extremity, 
which  is  rounded  off  without  anything  like  a cicatrix,  and  has 
a small,  wart-like  excrescence  upon  one  side  near  its  termina- 
tion. This,  Mr.  B.  says,  made  its  appearance  some  years 
since,  and  was  not  a part  of  the  original  conformation.  The 
humerus  is  felt  to  be  somewhat  flattened,  so  as  to  spread  a 
little  transversely  at  the  lower  end,  as  if  there  were  an  effort 
at  the  formation  of  condyles.  All  the  movements  of  the 
shoulder-joint  are  perfect,  and  the  muscular  power  is  very  con- 
siderable. 

The  thigh-bones  are  about  a third  of  the  natural  length. 
The  extremity  of  each  of  the  stumps  has  a little,  mushroom- 
like appendix  or  fleshy  pad  attached  to  it ; that  on  the  right 
the  largest,  bearing  a certain  resemblance  to  a flattened  and 
boneless  great  toe,  and  capable  of  slight  voluntary  motions. 
The  left  is  smaller,  and  can  be  retracted  by  a voluntary  effort 
of  the  muscles  of  the  stump.  The  pelvis  is  said  to  be  narrow. 

The  left  upper  extremity  is  well  formed  and  exceedingly 
muscular.  Supporting  himself  upon  this,  he  is  able  to  move 
freely  about,  going  up  and  down  stairs,  crossing  the  room  in  a 
rapid  series  of  bounds,  and  throwing  himself  into  a chair  with 
the  most  perfect  ease. 

Otherwise,  Mr.  B.  seems  to  be  fully  developed,  and  he  is 
one  of  a large  family,  all  of  whom  are  well  formed.  His 
general  health  is  quite  good,  and  his  weight  is  at  present 
ninety-two  pounds,  but,  at  the  age  of  twenty-three,  was,  as  he 
says,  one  hundred  and  seventeen. 

The  drawing  was  made  by  Dr.  William  T.  Parker. 

819.  Drawing  of  a monstrosity,  which  was  presented  to  the  Society 
by  Dr.  Abner  B.  Wheeler.  The  parietes  of  the  abdomen  were 
wanting  upon  the  right  side  and  in  front,  so  that  the  intestines 
and  a large  part  of  the  liver  protruded,  forming  a mass  as 


MONSTROSITIES. 


293 


large  as  the  fist.  The  intestines  were  very  much  matted 
together,  had  a thickened,  fleshy  look  and  feel,  and  were  of  a 
deep  red  color,  there  being  also  a considerable  effusion  of 
greenish  yellow  lymph  over  the  peritoneal  surface. 

The  right  lower  extremity,  as  shown  in  the  drawing,  was 
entirely  wanting,  but  the  left  was  well  developed.  This  last 
stood  off  at  a right  angle  from  the  trunk,  the  knee  was  strongly 
flexed,  and  the  foot  turned  inwards ; the  toes  were  malformed, 
the  first  being  sufficiently  large,  but  scarcely  separated  from 
the  second,  the  second  and  third  fused,  the  fourth  distinct,  and 
the  fifth  large  and  widely  separated  from  the  rest. 

Otherwise,  the  foetus  was  well  formed  externally,  except  for 
some  lateral  compression  of  the  thorax.  Sex  female.  Weight 
two  pounds  and  a quarter. 

On  dissection,  the  right  internal  iliac  artery  was  found  to  be 
no  larger  than  a small  thread,  the  left  being  of  full  size.  The 
right  sacral  nerves  were  also  exceedingly  small,  excepting  the 
first.  The  uterus  was  of  a conical  form,  the  apex  being  in- 
clined towards  the  left  side,  and  giving  off  the  Fallopian  tube ; 
left  ovary  well  developed  ; right  tube  and  ovary  wanting.  The 
other  abdominal  organs  were  not  remarkable  except  for  what 
is  said  above  of  the  liver  and  intestines.  In  the  thorax  there 
was  considerable  serous  effusion,  and  the  arch  of  the  aorta 
gave  off  four  vessels  of  about  equal  size,  but  otherwise  nothing 
unusual  was  observed. 

The  mother  had  previously  had  one  well  formed  child,  and 
felt  the  motions  of  this  last  as  much  as  she  did  those  of  the 
first.  Labor  came  on  at  the  end  of  the  seventh  month ; the 
head  presented,  the  quantity  of  liquor  amnii  was  smaller  than 
usual,  and  the  child  and  placenta  were  expelled  together.  The 
heart  beat  for  about  ten  minutes,  and  the  child  gasped  a few 
times  after  it  was  born,  a general  convulsion  being  produced 
whenever  it  was  moved. 

The  drawing  was  made  by  Dr.  Jeffries  Wyman. 

820.  Skeleton  of  the  above  monstrosity.  A small  bone,  measuring 
about  two  by  three  lines,  is  connected  with  the  right  side  of  the 
sacrum,  and  upon  this  there  was,  when  recent,  a rounded  car- 
tilage, about  a line  in  diameter,  but  otherwise  there  is  no  trace 
of  a right  lower  extremity.  The  left  lower  extremity  is  in  the 


294 


MONSTROSITIES. 


position  in  which  it  is  above  described,  the  os  innominatum  be- 
ing well  developed,  as  is  the  rest  of  the  skeleton.  1839. 

Dr.  Abner  B.  Wheeler. 

821.  Placenta  from  the  above  case  ; injected  and  dried.  The  mem- 
branes are  connected  with  the  cord  throughout,  which,  in  the 
recent  state,  was  but  three  inches  and  a quarter  in  length ; 
they  were  also  continuous  with  the  integuments  of  the  foetus 
about  the  right  hypochondrium,  and  adhered  slightly  to  the  left 
lobe  of  the  liver. 

822.  Cast  in  plaster  of  an  upper  extremity.  The  arm  was  well 
formed ; the  fore-arm  was  pretty  well  developed,  but  bent  to  a 
right  angle  upon  the  arm,  and  measured  but  seven  inches  in 
length  ; the  hand  was  bent  to  a right  angle  upon  the  fore-arm, 
and  sufficiently  developed,  except  for  the  thumb,  which  was  in 
a very  rudimentary  state,  and  connected  with  the  integument 
by  a small  peduncle. 

The  subject  of  this  malformation  was  a man,  thirty-five 
years  of  age,  who  died  at  the  Almshouse,  October  21st,  1844, 
and  was  known  during  life  to  have  had  a good  use  of  the  limb. 

The  dissection  was  made  by  Dr.  B.,  who  found  the  muscles 
developed  in  accordance  with  the  condition  of  the  bones  (No. 
823) ; the  biceps  was  attached  to  the  ligament  which  usually 
connects  the  radius  and  ulna ; the  nerves  ran  in  a perfectly 
straight  course,  but  the  arteries  were  much  contorted. 

The  cast  was  taken  by  Dr.  Henry  J.  Bigelow. 

823.  A ligamentary  preparation  of  the  upper  extremity  just  de- 

scribed ; by  Dr.  Samuel  Cabot.  The  radius  is  seen  to  be  en- 
tirely wanting.  The  ulna  is  strongly  developed,  but  curved 
upon  itself,  and  measures  six  inches  and  three-fourths  in  a 
straight  line.  The  inferior  articulating  surface  of  the  humerus 
is  narrow,  as  it  receives  only  the  ulna,  but  that  portion  is  most 
developed  with  which  the  radius  is  usually  connected ; other- 
wise this  bone  is  well  formed.  The  bones  of  the  hand  are 
well  developed,  except  for  the  thumb,  which  consists  of  two 
rudimentary  phalanges,  upon  the  last  of  which  is  a small  nail ; 
the  trapezium  also  is  wanting.  Dr.  Winslow  Lewis. 


MONSTROSITIES. 


295 


824.  A rhinencephalous  pig ; preserved  in  spirit.  The  eyes  are 
contained  in  a common  orbit,  but  the  fusion  is  not  complete  ; 
the  proboscis  is  directly  above  them,  and  is  about  one  inch  and 
three-fourths  in  length,  and  one-fourth  of  an  inch  in  diameter. 

825.  A second  specimen.  This  subject  was  older  than  the  last ; 
the  fusion  of  the  eyes  is  less  complete,  and  between  them  and 
the  proboscis  the  cranium  appears  to  be  deficient,  or,  at  least, 
the  integuments  are  wanting.  This  last  complication  is  very 
unusual. 

826-30.  The  following  specimens  of  “Blighted  Foetus”  had  the 
flattened,  bloodless,  macerated  look,  which  is  generally  seen  in 
these  cases,  and,  as  usual,  they  were  all  cases  of  twins,  the 
other  foetus  being  well  formed. 

826.  The  first  specimen  is  shown  in  Fig.  27,  and  weighs  only  ninety- 

two  grains.  The  trunk  is  one  and  a half  inches  in  length, 
smooth  on  the  surface  and  quite  firm,  and  terminates  bluntly, 
without  any  trace  of  a head  or  upper  extremities.  The  pelvis, 
however,  exists,  and  the  lower  extremities  are  tolerably  devel- 
oped ; legs  crossed,  and  strongly  flexed,  so  as  to  come  in  con- 
tact with  the  body,  the  left  foot  being  also  bent  into  contact 
with  the  leg ; right  foot  very  imperfect.  Labor  occurred  at 
seven  and  a half  months,  and  the  perfect  child  was  born  first. 
1838.  Dr.  William  J.  Walker. 

827.  The  second  specimen  (Fig.  28)  is  four  inches  in  length,  two 
in  width,  and  was  enclosed  in  a distinct  cavity  attached  to  the 
placenta  of  a full  grown  fcetus.  In  this  case  the  lower  ex- 
tremities are  wanting,  but  the  head  exists ; also,  the  spinal 
column,  the  ribs,  the  scapulae,  and  one  of  the  upper  extremi- 
ties are  seen  ; this  last  adhering  to  the  trunk.  1834. 

Dr.  John  Odin. 

828.  The  third  specimen  is  about  the  size  of  a five  months  fcetus, 
the  external  parts  generally  being  well  developed  ; enclosed  in 
a sac,  which  was  connected  with  the  placenta  of  a large  and 
vigorous  foetus  ; cord  fourteen  inches  in  length.  1830. 

Dr.  Joseph  W.  McKean. 


296 


MONSTROSITIES. 


829.  The  fourth  specimen  is  less  developed  than  the  last,  the  weight 

being  less  than  five  ounces  ; connected  with  the  placenta  of  a 
mature  foetus.  This  case  is  remarkable  for  the  strong  flexion 
of  the  limbs,  and  for  being  enveloped  in  an  abundant,  soft, 
ragged,  adventitious  deposit.  1829.  Dr.  John  Ware. 

830.  A cranium,  prepared  to  show  the  great  overlapping  of  the 
bones  which  takes  place  in  the  blighted  foetus,  when  the  de- 
velopment is  sufficiently  advanced.  In  the  recent  state,  the 
subject  of  this  case  resembled  No.  828,  and  a healthy  eight 
months  foetus  was  born  at  the  same  time. 

Dr.  D.  H.  Storer. 

831.  A human  foetus,  between  two  and  three  months  old,  and 
affected  with  hare-lip  upon  the  left  side.  1830. 

Dr.  J.  H.  Lane. 

832.  The  superior  maxillary  bones  of  a six  months  foetus,  that  was 
affected  with  hare-lip.  That  on  the  left  side  wants  the  two 
first  alveoli,  but  is  otherwise  well  formed ; the  alveolus  for  the 
first  incisor,  however,  exists  as  an  intermaxillary  bone,  and  is 
connected  by  a slender  process  with  the  vomer.  The  right 
superior  maxillary  is  sufficiently  developed. 

833.  A drawing  of  the  right  hand  of  a child  between  two  and  three 

years  old.  The  fingers  are  closely  united,  and  there  is  a sin- 
gle, continuous  nail  extending  across  the  whole,  the  outline  of 
the  fingers  being  distinctly  felt.  The  thumb  is  well  developed, 
and  the  hand  is  otherwise  sufficiently  well,  except  that  the  ar- 
ticulation of  the  middle  finger  with  the  metacarpus  is  not  in  a 
line  with  the  rest.  The  case  occurred  (1847)  in  the  practice 
of  Dr.  Anson  Hooker,  of  East  Cambridge,  and  the  drawing 
was  made  by  Dr.  Jeffries  Wyman. 

A somewhat  similar  case  was  reported  not  long  since  to  the 
Society,  but  in  which  the  deformity  was  considerably  greater, 
the  right  hand  being  here  also  affected.  The  thumb  was 
wanting ; three  fingers  only  could  be  felt,  and  these,  with  three 
metacarpal  bones,  were  more  or  less  imperfect ; nail  not  per- 
fectly continuous,  but  divided  towards  one  of  the  edges  into 
two  portions.  The  subject  of  this  case  was  a well  formed 


MONSTROSITIES. 


297 


child,  about  two  years  old,  and  a patient  of  Dr.  Edward  Jarvis, 
of  Dorchester. 

ii.  Monstrosities  by  excess. 

834.  “ Two  male  children,  well  grown,  united  from  the  shoulders 
on  one  side  to  the  navel ; there  is  but  one  umbilical  cord ; the 
thorax  is  common  to  both,  having  no  partition,  and  but  one 
heart ; the  aortas  have  an  arch  from  two  ascending  arteries, 
arising,  apparently,  from  each  superior  corner  of  the  heart.” 
The  above  account  of  this  specimen  is  from  the  Boston  Med- 
ical Intelligencer,  for  August  19th,  1823.  The  union  seems 
now  to  be  rather  anterior  than  lateral. 

Dr.  George  Parkman. 

835.  Skeleton  of  two  female  children,  that  were  united  face  to  face 
from  the  top  of  the  sternum  to  the  umbilicus,  being  otherwise  well 
formed,  as  is  the  last  specimen,  which,  in  the  recent  state,  it  very 
perfectly  resembled.  Weighed  nine  pounds  and  two  ounces, 
and  was  quite  fresh  when  received,  but  died  probably  during  the 
delivery,  there  being  some  laceration  of  the  soft  parts,  with 
fracture  of  some  of  the  bones  ; the  mother  also  died  in  conse- 
quence of  the  difficulty  of  the  labor. 

The  thorax  forms  one  large,  continuous  cavity,  and  has  a 
sternum  upon  each  side,  but  these  last,  instead  of  being  dis- 
tinct, as,  according  to  St.  Hilaire,  they  usually  are  in  these 
cases  (III.  95,)  are  united  so  as  to  form  an  arch  above  the 
common  cavity. 

On  dissection  of  this  foetus,  the  alimentary  canal,  the  pan- 
creas, the  spleen,  the  urinary  and  genital  organs,  the  thymus 
gland,  and  the  vocal  and  respiratory  organs  were  found  to  be 
in  double  sets  and  well  formed  ; some  adhesions  only  existing 
between  the  intestines  and  the  other  parts.  The  principal 
nerves  were  also  dissected. 

The  diaphragm  formed  one  large  and  continuous  arch  be- 
tween the  two  foetuses. 

The  two  livers  were  united,  but  appeared  to  be  no  larger 
than  the  single  organ  in  a foetus  at  the  term.  A single  broad 
ligament  extended  from  the  umbilicus  along  each  face  of  the 
organ  to  the  diaphragm,  making  the  two  abdominal  cavities 
38 


298 


MONSTROSITIES. 


quite  distinct.  There  were  two  umbilical  veins  and  a gall- 
bladder upon  each  face  of  the  organ,  the  ducts  being  distributed 
as  usual. 

The  two  hearts  were  united  to  form  one  common  organ,  the 
ventricular  portion  resembling  somewhat,  in  its  breadth,  the 
heart  of  a tortoise.  There  was  but  a single  auricle,  irregular 
on  the  inner  surface,  and  having  a band  running  across  it  mid- 
way, but  with  nothing  that  could  be  called  a septum  ; two  ap- 
pendices were  found  at  each  extremity,  with  the  pulmonary 
veins  and  the  superior  vena  cava  of  each  foetus.  The  ven- 
tricular portion  consisted  of  two  cavities,  the  septum  being 
perfect,  except  for  a small  opening  at  the  upper  part ; auriculo- 
ventricular  valves  well  developed.  At  one  extremity  of  this 
ventricular  portion  there  arose  an  aorta  which  was  in  every 
way  normal,  and  by  its  side  a pulmonary  artery,  smaller  than 
itself,  and  having  but  two  valves  ; at  the  other  extremity  there 
was  another  aorta,  which  gave  off  the  pulmonary  artery. 
The  only  peculiarity  noticed  in  the  vessels  was  the  existence 
of  but  one  umbilical  artery  in  one  of  the  foetuses.  1837. 

Dr.  Nathaniel  Miller , of  Franklin. 

836.  Drawing  of  a monstrosity  that  was  sent  to  the  Society  by 
Dr.  E.  T.  Learned,  of  Weymouth.  The  subject  of  this  case 
consisted  of  two  foetuses,  which  were  united  from  above 
downwards,  but  separate  below  the  umbilicus : having  two 
perfect  faces,  four  upper  extremities,  and  being  well  formed 
externally,  except  for  the  fusion.  Sex  male.  Weight  twenty- 
four  ounces,  and  length  of  the  spines  three  inches  and  a 
fourth. 

The  mouth  of  each  foetus  opened  posteriorly  into  a common 
pharynx,  from  which  descended  the  oesophagus  (Figure  22.) 
Below  the  diaphragm  there  was  seen  the  stomach,  which,  when 
distended,  urns  about  the  size  of  a large  cherry  (No.  83S) ; 
this  communicated  with  a portion  of  intestine,  about  one  inch 
and  a quarter  in  length,  and  this  opened  into  a cavity  which 
sent  off  a separate  intestine  to  each  foetus,  the  small  intestine 
being  seven  inches  in  length,  and  the  large  eight  inches,  with- 
out including  the  rectum.  The  liver  was  decomposed,  and  unfit 
for  examination.  Urinary  and  genital  organs  double,  and  well- 
formed  ; the  respiratory  organs  were  also  double,  with  the  thy- 
roid and  thymus  glands. 


MONSTROSITIES. 


299 


There  were  two  separate  hearts.  Each  had,  at  least,  one 
auricle,  and  in  one  of  them  there  was  an  appearance  of  a 
second ; each  had  also  two  ventricles,  which  communicated 
freely,  and  gave  off  from  their  common  cavity  an  aorta  and  a 
pulmonary  artery,  the  vessels  being  distributed  as  follows. 
Each  aorta  gave  off  two  carotids,  after  which  the  arch  became 
very  small.  One  of  the  pulmonary  arteries  gave  its  branches 
to  the  lungs,  and  its  ductus  arteriosus  to  the  aorta,  which  after- 
wards sent  off  the  two  subclavians.  The  other  pulmonary 
artery  gave  its  branches  to  the  lungs,  and  then  a large  branch 
which  formed  the  second  descending  aorta,  from  which  one 
subclavian  artery  was  seen  to  arise  ; the  second  having  proba- 
bly been  cut  off ; the  ductus  arteriosus  was  then  given  off,  and, 
after  having  joined  the  arch  of  the  aorta,  opened  at  once  into 
the  first  descending  aorta,  and  thus  formed  a free  communica- 
tion between  the  two. 

The  drawing  was  made  by  Dr.  Jeffries  Wyman. 

837.  Skeleton  of  the  above  monstrosity  ; not  mounted.  The  head 
contains  two  entire  sets  of  bones,  which  are  sufficiently  devel- 
oped for  the  age  of  the  subject,  though  somewhat  crowded  ; 
most  of  them  have  been  detached,  but  those  of  the  base  still 
remain  in  connection,  and  are  represented  in  Figure  21.  The 
sphenoids  are  the  only  ones  that  require  any  particular  notice  ; 
the  body  of  each  of  these  bones  is  divided  longitudinally  into 
two  equal  portions,  and  each  revolves  one-quarter  of  a circle, 
so  as  to  bring  the  posterior  edges  of  the  two  corresponding 
portions  into  opposition  ; the  inner  lateral  edges  of  each  sphe- 
noid, then,  are  opposed  to  those  of  the  opposite  sphenoid, 
whilst  the  outer  lateral  edges  are  opposed  to  the  basilar  portion 
of  the  occiput  and  to  the  temporal  bone.  This  is  certainly 
very  different  from  a figure  of  a similar  case  by  Serres,  in  the 
Memoirs  of  the  Institute  (vol.  55.) 

The  large  and  small  wings  are  sufficiently  well,  except  that 
three  of  the  last  retain  their  early  fcetal  condition  of  being  dis- 
tinct bones.  The  other  bones  are  not  remarkable,  except  for 
some  difference  in  the  size  of  the  parietals  in  the  two  subjects, 
and  a fusion  of  the  two  portions  of  each  frontal  bone.  The 
thorax  is  double,  as  usual  in  these  cases,  and  the  two  skeletons 
are  otherwise  well  formed.  1836. 

Dr.  E.  T.  Learned,  of  Weymouth. 


300 


MONSTROSITIES. 


838.  A model,  in  wax,  of  the  oesophagus,  stomach,  and  upper  part 
of  the  intestine,  from  the  above  monstrosity ; as  already 
described. 

839.  A foetal  Calf,  preserved  in  spirit,  the  age  of  the  subject  being 
perhaps  two  or  three  months.  Malformation  as  in  the  last  case, 
except  that  one  of  the  faces  is  somewhat  imperfect. 

840.  A double  Pig,  similar  to  No.  836,  except  that  instead  of  a 
second  face,  an  ear  only  is  found,  perhaps  a fusion  of  two.  A 
stuffed  specimen. 

Some  years  since,  a human  subject,  showing  this  same  form 
of  monstrosity,  was  brought  from  Siam,  and  was  in  the  Socie- 
ty’s cabinet  for  a time,  but  was  afterwards  removed. 

841.  A double  Guinea-pig,  preserved  entire  in  spirit.  Malforma- 
tion as  in  the  last  case.  Dr.  George  B.  Doane. 

842.  A double  Chicken,  preserved  entire  in  spirit,  and  malformed 
like  the  last  specimen ; there  is  also  a lateral  distortion  of  the 
upper  mandible.  This  form  of  monstrosity  is  common  in  the 
mammalia,  but  St.  Hilaire  does  not  mention  its  occurrence 
in  birds.  1845.  Dr.  Francis  W.  Cragin,  of  Surinam. 

A second  specimen  has  lately  been  received,  and  resembles 
the  one  just  described,  except  that  the  upper  mandible  is  not  dis- 
torted. Upon  the  back  of  the  head  there  is  seen  the  external  open- 
ing of  the  central  ear,  or  perhaps,  from  the  size,  a fusion  of  two. 

843.  A double  Kitten,  preserved  entire  in  spirit.  Malformation  as 
in  No.  840,  except  that  the  ear  on  the  back  of  the  head  is 
wanting. 

844.  Skeleton  of  a double  Lamb ; not  mounted.  Externally,  this 
subject  resembled  the  last,  as  a monstrosity,  except  for  some 
peculiarities  about  the  head.  Below  the  angle  of  the  jaw, 
upon  the  right  side,  was  a narrow  fissure,  one  and  a half  inches 
in  length,  opening  largely  into  the  pharynx,  and  at  its  posterior 
extremity,  on  separating  its  edges,  was  seen  a malformed  in- 
ternal ear.  The  external  ear,  upon  the  left  side,  was  well 
formed,  but  the  right,  which  was  situated  not  far  from  the  fis- 


MONSTROSITIES. 


301 


sure,  terminated  in  a cul  de  sac,  though  otherwise  well  devel- 
oped. Secondly,  there  were  beneath  the  anterior  extremity 
of  the  lower  jaw,  and  inclining  to  the  left  side,  two  incisor 
teeth,  the  relations  of  which  will  be  hereafter  described. 

On  dissection,  there  was  seen  on  the  back  of  the  pharynx  a 
fold  of  membrane,  which  was  evidently  the  rudiment  of  a 
second  palate,  and  beneath  this  some  appearance  of  the  root  of 
a second  tongue.  (Esophagus  single,  and  well  formed. 

The  stomach  was  formed  by  the  fusion  of  two  organs.  The 
fourth,  or  digestive  cavity,  was  single,  but  very  large,  measur- 
ing, in  a collapsed  state  and  before  being  opened,  four  and  a half 
inches  in  length,  and  one  and  a half  inches  transversely.  Of 
each  of  the  three  other  cavities  there  was  a double  set,  those 
which  corresponded  being  equally  developed.  The  first  ex- 
tended off  two  inches  from  the  lower  extremity  of  the  oeso- 
phagus upon  each  side,  and  was  about  two-thirds  of  an  inch 
in  diameter.  Where  these  two  opened  into  the  fourth  cavity 
there  were  seen,  closely  grouped  together,  four  others,  each  of 
which  was  about  one-third  of  an  inch  in  diameter ; these,  of 
course,  were  the  second  and  third  cavities,  and  one  of  each  of 
them  was  situated,  side  by  side,  on  each  face  of  the  stomach, 
or  between  the  two  first  cavities. 

The  intestine  continued  single  for  seven  feet  and  a half,  and 
then  divided,  one  portion  consisting  of  thirty  inches,  each,  of 
small  and  large  intestine,  and  the  other  of  about  thirty-four 
inches,  each,  of  the  same.  Just  at  the  division  there  was  a 
sort  of  diverticulum,  six  and  a half  inches  in  length,  termi- 
nating in  a cul  de  sac,  and  lying  free  in  the  cavity  of  the  ab- 
domen ; this  appendage  was  not  uniform  in  size,  but  was  in 
some  parts  considerably  smaller,  though  nowhere  larger  than 
the  intestine  itself. 

There  were  two  distinct  livers,  one  being  somewhat  larger 
than  the  other,  and  each  having  its  gall-bladder,  ducts  and  ves- 
sels ; the  umbilical  vein  entering  upon  the  convexity  of  the 
organ.  There  were  also  two  distinct  sets  of  urinary  and  ge- 
nital organs. 

The  lungs,  trachea,  and  thymus  gland  were  in  double  sets 
and  well-formed.  The  larynx,  which  corresponded  to  the  face 
of  the  animal,  was  also  normal,  though  the  cornu  of  the  hyoid 
bone  on  the  right  side,  and  in  connection  with  the  fissure  in  the 


302 


MONSTROSITIES. 


neck,  was  imperfectly  developed.  The  other  larynx  was  alto- 
gether small,  and  the  cornua  of  the  hyoid  bone,  which  were 
otherwise  not  remarkable,  were  so  closely  connected  as  to  ap- 
pear like  one  bone  before  they  were  separated. 

Two  distinct  hearts  were  found  ; one  was  decidedly  larger 
than  the  other,  but  both  of  them  sufficiently  developed,  and, 
seeming  to  be  externally  well  formed,  were  not  cut  open.  An 
aorta  and  pulmonary  artery  arose  from  each,  and  communi- 
cated, as  usual,  by  the  ductus  arteriosus.  The  arch  of  each 
aorta  gave  off  a single  vessel  which  very  soon  divided  into  the 
two  carotids ; one  of  these  vessels  being  proportioned  to  the 
size  of  the  head  of  the  animal,  but  the  other  quite  small.  At 
some  distance  beyond  the  arch  each  aorta  gave  off  two  sub- 
clavians,  directly  opposite  to  each  other.  At  the  arch  the  two 
aortas  communicated  by  a vessel  which  was  about  the  size  of 
either  of  the  ascending  portions. 

Of  the  skeleton.  — The  cranium  is  single  in  front,  but  is  not 
well  formed,  there  being  a want  of  Symmetry  between  the  two 
sides  ; posteriorly,  it  is  quite  broad,  and  formed  by  the  fusion 
of  two.  There  are  two  occipital  foramina,  two-thirds  of  an 
inch  apart,  one  being  of  full  size  and  well  formed,  the  other 
considerably  larger  and  somewhat  irregular.  The  lateral  and 
two  basilar  portions  of  the  occiput  are  quite  distinct,  these  last 
being  connected  with  a common  but  broad  sphenoid  bone,  and 
also  with  each  other  through  nearly  half  their  extent ; the  pos- 
terior portions  are  less  distinct,  being  partially  fused  with  the 
parietals.  Of  these  last  there  seem  to  be  two  sets,  and  con- 
nected with  each  an  interparietal.  Between  the  lateral  por- 
tions of  the  occiput  are  a few,  small  and  very  irregular  bones 
upon  the  median  line,  to  represent  the  face  of  the  second  foe- 
tus. Upon  the  left  side  the  temporal  bone  is  well  developed, 
but  on  the  right  the  bony  cavity  connected  with  the  tympanum 
is  very  imperfect,  its  internal  structure  being  exposed  in  the 
form  of  a very  irregular  surface,  which,  when  recent,  was 
covered  by  a thin,  delicate  membrane,  and  was  seen  in  this 
state  at  the  bottom  of  the  fissure  which  opened  externally  be- 
neath the  lower  jaw.  There  is  much  lateral  distortion  of  the 
lower  jaw,  especially  on  the  right  side,  and  connected  with  the 
posterior  inferior  portion  of  the  symphisis  is  a small,  distinct 
bone  which  contains  two  incisor  teeth,  (Fig.  23,)  the  atrophy 


MONSTROSITIES. 


303 


of  the  lower  jaw  being  much  greater  than  in  any  case  referred 
to  by  M.  St.  Hilaire,  where  he  treats  of  this  form  of  mon- 
strosity (III.  257.) 

The  bodies  are  connected  as  usual  in  these  cases,  the  ster- 
num and  ribs  corresponding  to  the  face  of  the  animal  being  well 
developed,  but  not  those  upon  the  opposite  side.  To  distin- 
guish the  two  bodies,  that  may  be  called  A which  corresponds 
to  the  right  side  of  the  face  of  the  animal,  and  the  other  B. 
The  spines  are  distinct  throughout,  and  have  the  usual  number 
of  vertebra.  The  spine  of  A has,  in  the  cervical  and  upper 
half  of  the  dorsal  portion,  a strong,  double  lateral  curvature, 
there  being  a considerable  atrophy  of  the  dorsal  wings  upon 
the  concave  side,  but  with  less  difference  in  the  neck,  where 
the  curvature  is  less  marked ; the  atlas,  however,  is  thrown 
quite  to  one  side  ; the  spinous  processes  and  wings  of  the  first 
six  dorsal  vertebra  are  fused,  and  also  the  seventh  and  eighth. 
The  spine  of  B.  is  less  curved  in  its  dorsal  portion,  and  the 
cervical  very  little  if  at  all ; the  first  four  dorsal  wings  are 
fused,  also  the  fifth  and  sixth,  and  the  seventh  and  eighth.  B. 
has  thirteen  well  developed  ribs  on  each  side.  A.  has  a re- 
markable development  of  the  right  transverse  process  of  the 
vertebra  in  place  of  the  thirteenth  rib,  and,  as  it  seems  intend- 
ed to  represent  a rib,  this  vertebra  has  been  regarded  as  one  of 
the  dorsal ; the  fourth,  fifth,  sixth  and  seventh  ribs  on  the  left 
side  are  very  closely  fused  posteriorly,  but  anteriorly  divide 
into  two  portions,  otherwise  the  two  bodies  appear  to  be  well 
formed,  as  are  also  the  eight  extremities. 

The  subject  of  the  above  case  was  sent  to  the  Society  in 
May,  1843,  by  Dr.  Henry  C.  Perkins , of  Newburyport. 

845.  Skeleton  of  a double  Pig;  not  mounted.  — Externally,  this 
monstrosity  resembled  No.  841,  except  for  a deficiency  of  the 
vault  of  the  cranium,  and  that  there  was  no  additional  ear  upon 
the  back  of  the  head.  Plow  far  the  brain  was  developed,  if 
at  all,  could  not  be  ascertained,  as  the  spinal  marrow  had  been 
cut  off  at  its  upper  extremity,  being  there  of  about  the  proper 
size  ; the  specimen  had  been  in  spirit,  but  was  otherwise  in  a 
state  of  good  preservation.  The  posterior  portion  of  the  occi- 
put is  very  imperfectly  developed,  but  connected  as  usual  with 
the  lateral  portions,  and  forms  with  them  a high  wall  perpen- 


304 


MONSTROSITIES. 


dicular  to  the  base  of  the  cranium.  The  cranial  portion  of  the 
frontal  bones  is  wanting,  and  the  parietals  are  very  imperfectly 
developed ; these  last  being  separated  by  the  whole  width  of 
the  base  of  the  cranium.  The  palatine,  the  maxillary,  and,  to 
a certain  extent,  the  intermaxillary  bones,  are  separated,  as 
usual,  in  fissure  of  the  palate.  Otherwise,  the  cranium  is 
sufficiently  well  formed. 

The  two  spines  are  united  in  the  cervical  portion.  Posteri- 
orly, the  first  three  vertebrae  are  single  ; the  fourth  is  double, 
having  two  sets  of  wings,  and  something  like  a rudimentary 
one  between  them,  and  from  the  fifth  downwards  the  two  col- 
umns are  separate  throughout.  Anteriorly,  the  fusion  is  much 
less  complete,  the  two  rows  of  bodies  being  distinct  throughout ; 
the  first  body  in  each  spine  consists  of  two  bones,  one  above 
the  other,  and  between  those  of  the  second  vertebrae  there  is 
an  additional  bone  of  considerable  size  ; the  fourth,  and  all  be- 
low, are  well  formed.  The  spinal  canal  is  single  to  the  fourth 
vertebras.  The  thorax  is  formed,  as  usual,  by  a fusion  of  the 
two,  the  side  corresponding  to  the  back  of  the  head  being  im- 
perfectly developed.  The  extremities  which  correspond  to 
the  imperfect  side  have  the  scapulae  united  by  their  upper 
edges,  and  also  by  their  spines  (Figures  33  and  33'),  but  are 
otherwise  well  formed,  as  are  the  two  other  upper  extremities, 
and  both  sets  of  the  lower. 

On  dissection,  the  oesophagus  was  found  to  be  single,  but 
communicated  largely  throughout  with  the  larynx  and  trachea, 
as  has  been  observed  in  some  analogous  cases  (Anom.  des 
Org.  III.  144.)  The  stomach  (Fig.  34)  was  single,  but  formed 
by  the  union  of  two.  The  small  intestine  was  single  for  the 
first  thirty-two  inches ; it  then  became  dilated,  as  shown  in 
Figure  24,  and  from  this  second  cavity  there  arose  a double 
set  of  intestines,  the  small  measuring  between  five  and  six 
inches,  and  the  large  about  twenty-four  inches.  Two  inches 
above  the  dilatation  there  was  a diverticulum,  ten  fines  in 
length,  and  situated  parallel  to  the  intestine,  to  which  it  closely 
adhered,  except  near  the  extremity.  Both  subjects  were  males, 
and  there  was  nothing  unusual  in  the  genital  or  urinary  organs, 
excepting  that  one  set  of  kidneys  was  somewhat  smaller  than 
the  other.  The  hyoid  bone,  epiglottis,  larynx  and  trachea, 
corresponding  to  the  face  of  the  monstrosity,  appeared  to  be 


MONSTROSITIES. 


305 


well  developed,  except  that  the  two  last,  as  above  stated, 
opened  freely  into  the  oesophagus ; the  primary  bronchia  and 
the  lungs  were  also  sufficiently  developed.  About  opposite  to 
the  lower  part  of  the  trachea,  and  in  the  parietes,  as  it  were, 
of  the  oesophagus,  there  was  found  a second,  small,  rudiment- 
ary larynx,  below  which  was  a trachea  of  corresponding  de- 
velopment, two  bronchia,  and  a pair  of  lungs,  these  last  being 
about  one-third  or  one-half  as  large  as  the  first  pair.  A large 
blood-vessel  passed  down  between  the  cartilage  of  the  larynx 
and  its  mucous  surface,  running  parallel  to  and  in  front  of  the 
trachea,  and  dividing  to  send  a branch  to  each  lung,  as  it  were 
a pulmonary  artery ; its  origin,  however,  could  not  be  deter- 
mined, as  it  had  been  cut  off  about  half  an  inch  above  the  larynx. 

The  heart  was  single,  and  appeared  externally  well  formed, 
except  that  no  vessels  were  found  to  enter  the  left  auricle  ; a 
large  branch,  however,  entered  the  right  auricle,  and,  from  its 
situation,  was  probably  the  common  trunk  of  the  pulmonary 
veins.  Internal  structure  normal.  The  aorta  divided  almost 
at  once  into  two  large  trunks,  one  for  each  foetus ; and  these 
gave  off  branches,  which  must  have  been  the  carotids  and  sub- 
clavians.  The  pulmonary  artery  gave  off  two  small  pulmo- 
nary branches,  and  sent  to  each  aorta  a ductus  arteriosus,  these 
two  last  vessels  being  of  unequal  size. 

846.  A portion  of  small  intestine,  from  the  above  case,  injected, 
and  represented  in  Fig.  24.  St.  Hilaire  (II.  pp.  102  and  132) 
remarks  upon  dilatation  of  the  intestine  at  the  point  of  division 
as  very  rare,  but  refers  to  three  cases. 

847.  Skeleton  of  a double  Pig ; mounted. 

The  cranium  is  malformed  very  nearly  as  in  the  last  case, 
the  vault  being  open  superiorly,  and  the  cavity  quite  shallow. 
The  parietal  bones  form  the  lateral  boundary ; the  cranial  por- 
tion of  the  frontals  is  entirely  wanting,  as  is  also  the  posterior 
portion  of  the  occiput,  the  lateral  portions  being  well  devel- 
oped, but  widely  separated,  and  not  anchylosed  with  the  tem- 
porals, as  in  No.  845.  There  was  also  a fissure  through  the 
palate,  and  double  harelip,  the  maxillary  and  palatine  bones 
being  separated  as  usual,  with  a deficiency  of  the  facial  por- 
tion of  the  intermaxillaries. 

39 


306 


MONSTROSITIES. 


The  seven  cervical  and  first  dorsal  vertebra  are  single,  and 
then  the  spines  divide.  As  in  No.  844,  the  subject  which  cor- 
responds to  the  right  side  of  the  face  of  the  animal  may  be 
called  A,  and  the  other  B.  The  spine  of  B is  sufficiently 
developed  to  about  the  tenth  dorsal  vertebra,  but  with  a con- 
siderable lateral  curvature,  and  a fusion  of  two  or  three  wings 
upon  each  side  ; at  this  point  there  was  an  antero-posterior 
curvature,  and  below  this  it  is  open  as  far  as  the  sacrum,  as  in 
a case  of  spina  bifida,  the  bodies  and  expanded  wings  forming 
a broad,  flat  surface  ; there  are  five  lumbar  vertebra,  and  the 
sacral  and  coccygeal  are  probably  normal.  Upon  the  right 
side  the  wings  of  the  vertebra  of  A seemed  to  be  well  devel- 
oped as  low  as  the  sixth  dorsal,  but  with  a partial  fusion  of  the 
first  three  ; upon  the  left  side  there  are  seen  two  very  broad 
and  irregular  wings,  which  are  fused  with  those  of  the  right 
side.  Below  the  sixth  dorsal  vertebra  the  spine  is  open 
throughout  as  far  as  the  sacrum,  and  most  irregularly  and 
strongly  curved  or  rather  twisted  upon  itself,  producing  a de- 
gree of  shortening  such  that  in  the  recent  state  the  ilium  came 
nearly  into  contact  with  the  ribs ; upon  the  right  side  there  are 
the  wings  of  five  lumbar  vertebra,  and  with  these  are  con- 
nected the  bodies,  which  consist  of  two  broad  and  irregular 
bones,  but  upon  the  left  side  the  wings  are  entirely  wanting ; 
the  sacral  vertebra  are  imperfect,  and  the  coccygeal  entirely 
wanting.  The  thorax,  which  corresponds  to  the  face  of  the 
animal,  is  sufficiently  developed ; the  ribs  on  the  left  side  of 
A,  are  fully  so,  except  for  a fusion  of  the  first  two,  the  whole 
number  being  fourteen ; upon  the  right  side  of  B there  are 
thirteen,  and  they  are  more  compressed.  The  thorax,  which 
corresponds  to  the  occiput  of  the  animal,  is  represented  by 
fourteen  ribs,  all  of  which  are  separate  but  much  compressed, 
the  first  one  or  two  belonging  to  the  left  side  of  A,  and  the 
others  to  the  right  side  of  B. 

The  pelves  and  extremities  are  well  formed. 

Before  dissection  the  condition  of  the  head  and  of  the  spines 
corresponded  with  that  of  the  skeleton  as  above  described  ; 
there  were  but  two  upper  extremities,  and  the  two  lower  of 
each  of  the  subjects  were  united  by  integument  as  far  down 
as  the  middle  of  the  leg.  The  organs  of  the  abdomen  had 
been  mostly  removed,  but  there  remained  for  B an  intestine, 


MONSTROSITIES. 


307 


left  kidney,  bladder,  testicles  and  penis ; in  A there  was  the 
right  kidney,  the  testicles,  and  an  imperfect  bladder,  but  no 
intestine.  The  thoracic  organs  had  not  been  disturbed,  and 
were  found  normal,  the  aorta  dividing  for  the  two  subjects  just 
above  the  diaphragm.  1834. 

Dr.  Francis  W.  Cragin , of  Surinam. 

848.  The  cranium  of  a double  Pig ; mounted.  This  specimen 
differs  from  any  in  the  present  series  (p.  298),  inasmuch  as 
there  is  a common  central  orbit,  and  the  anterior  as  well  as  the 
posterior  portion  is  composed  of  the  parts  of  two  individuals. 
The  occipital  foramina,  the  basilar  and  posterior  portions  of 
the  occiput,  the  parietal,  frontal,  and  nasal  bones  are  double 
and  well  developed,  though  somewhat  irregular  ; the  anterior 
portion  of  the  two  faces  being  not  merely  approximated,  but 
to  some  extent  overlapping  ; one  of  the  parietals  also  consists 
of  two  pieces.  Upon  the  outer  half  of  each  cranium  the 
lateral  portion  of  the  occiput,  the  temporal,  the  os  unguis,  the 
malar,  and  the  intermaxillary  bones  are  well  developed ; the 
upper  maxillary  of  each,  however,  is  deficient  throughout  in 
its  palatine  portion,  there  being  a fissure  of  the  palate  as  in  the 
last  case.  Upon  the  inner  half  of  each  cranium  the  temporal 
bones  are  very  imperfectly  developed  and  completely  fused  ; 
the  tympanic  cavities  are  much  compressed,  situated  di- 
rectly between  the  two  occipital  foramina,  and  show  no  trace 
of  a division  ; the  squamous  portions  consist  of  a single  broadly 
expanded  bone,  bounded  by  the  parietals  and  the  occiput,  and 
having  in  its  centre  a common  meatus,  the  vaginal  process  of 
each  bone  being  well  marked  ; the  petrous  portions  are  situ- 
ated between  the  two  basilars.  The  central  orbital  cavity  is 
formed  mainly  by  the  frontal  bones  and  the  anterior  sphenoids  ; 
each  of  these  last  is  perforated  by  a large  optic  foramen,  and 
the  two  bones  are  intimately  fused  together,  and  also  with  the 
posterior  sphenoid  of  the  subject  which  may  be  called  A,  with 
the  vomer  of  A,  and  with  a bone  of  some  size  which  may 
perhaps  be  the  ascending  portion  of  the  palatine  of  B,  there 
being  nothing  corresponding  to  this  last  in  the  other  subject. 
Between  the  central  orbit  and  the  base  of  the  skull  there  is 
now  seen  to  be  a free  opening,  and  this  is  divided  by  a 
bony  partition  which  seems  to  be  formed  by  the  internal  wings 


308 


MONSTROSITIES. 


of  the  posterior  sphenoids,  that  of  B,  however,  being  detached 
from  the  body  of  the  bone  ; there  are,  of  course,  two  basilar 
bones,  and  a posterior  sphenoid  connected  with  each.  In  front 
of  the  central  orbit  the  os  unguis  of  each  subject  is  largely 
developed,  but  the  superior  maxillary  bones  are  in  the  most 
rudimentary  state,  and  show  no  trace  of  alveoli ; the  nasal 
cavity  is  open  throughout ; the  intermaxillaries  are  very  im- 
perfect, and  particularly  that  of  A,  which  contains  only  one 
incisor  tooth.  The  lower  jaw  is  single,  the  branch  correspond- 
ing to  A being  shorter  than  the  other,  and  flaring  outward. 

The  rest  of  the  skeleton  has  been  preserved  separately,  but 
not  fully  prepared  ; there  are  four  upper  and  four  lower  ex- 
tremities, and  the  thorax  is  formed,  as  usual  in  these  cases,  by 
a fusion  of  the  two. 

As  this  subject  was  in  a state  of  advanced  putrefaction, 
when  received,  the  dissection  was  hastily  made,  and  those 
parts  only  will  be  mentioned  which  were  particularly  exam- 
ined. In  the  central  orbit  were  two  distinct  eyes,  and  upon 
the  back  of  the  head  a large  double  ear.  The  oesophagus 
was  single,  and  situated  between  the  two  tracheae  ; stomach 
formed  as  in  No.  845 ; small  intestine  well  developed,  and 
single  to  within  nine  inches  of  its  lower  extremity,  where  it 
divided,  but  without  any  dilatation  at  this  part;  at  the  umbili- 
cus was  a considerable  hernia.  The  respiratory  organs  were 
double,  but  both  sets  of  lungs  were  very  imperfectly  developed  ; 
one  larynx  also  being  imperfect,  and  the  cornua  of  the  hyoid 
bone  closely  compressed,  as  in  No.  844.  The  two  hearts 
were  widely  separated,  and  each  had  its  pericardium  ; internal 
structure  of  both  normal ; the  vessels,  entering  and  leaving  the 
organs,  were  all  of  them  traced,  excepting  the  pulmonary 
veins,  which,  owing  probably  to  the  undeveloped  state  of  the 
lungs,  must  have  been  very  small  and  were  not  found.  The 
two  aortas  communicated  at  the  arch  by  a vessel  which  was 
of  considerable  length,  and  fully  equal  in  size  to  either  trunk ; 
one  aorta  passed  over  the  left  primary  bronchus,  and  the  other 
over  the  right  of  the  other  set  of  lungs,  as  in  No.  850,  and, 
lastly,  each  aorta  sent  off  at  the  arch  two  vessels,  one  of  which 
soon  divided.  1847.  Dr.  John  C.  Warren. 

849-57.  In  the  present  series,  which  is  the  reverse  of  the  last 


MONSTROSITIES. 


309 


(836-48),  the  duplication  commences  with  the  head,  and  the 
fusion  goes  on  from  above  downwards. 

849.  A double-headed  Fish,  preserved  in  spirit. — The  two  heads 

are  about  equally  developed,  and  the  fusion  commences  just 
behind  the  pectoral  fins,  the  spines  being  traced  separately  to 
behind  the  anus.  Each  individual  has  a dorsal  fin,  and  two 
pectorals,  but  the  anus  and  a single  pair  of  ventral  fins  are 
common  to  the  two.  The  specimen  belongs  to  the  genus  Pi- 
melodus,  and  measures- one  inch  and  three-fourths  in  length, 
and  one-third  of  an  inch  from  the  anterior  extremity  to  the 
point  of  fusion.  It  was  taken  in  the  Gulf  of  Mexico,  by  Lieut. 
White  of  the  U.  S.  Navy,  he  having  caught  it  in  his  hand. 
1846.  Epes  S.  Dixivell,  Esq. 

850.  A drawing  of  the  alimentary  canal  of  a monstrosity  that  was 
born  in  the  practice  of  Dr.  Nathaniel  Ruggles,  of  Nantucket, 
in  June,  1846,  and  was  subsequently  examined  in  this  city. 
It  has  been  represented  in  Fig.  26,  and  the  following  account 
of  the  case,  as  it  was  reported  to  the  Society,  is  here  given, 
by  the  permission  of  Dr.  R. 

The  subject  of  this  case  had  two  heads  and  necks,  which 
were  distinct  throughout,  one  pair  of  upper  and  lower  ex- 
tremities, and  a trunk  which  was  formed  by  the  fusion  of  two. 
Sex  male.  The  mother  was  a middle-aged  woman,  and  this, 
which  was  her  first  labor,  occurred  about  the  end  of  the  eighth 
month.  One  of  the  heads  presented,  but  Dr.  R.  brought  down 
the  feet,  and  after  three  hours  accomplished  the  delivery, 
much  force  being  required ; the  children  lived  about  twenty- 
five  minutes.  Weight  five  pounds  and  a half.  A hasty  ex- 
amination of  the  organs  was  made  at  the  time  by  Dr.  C.  T. 
Collins,  of  New  York,  and  Dr.  Ruggles,  and  a short  account 
of  the  case  was  published  by  Dr.  C.  in  the  New  York  Med. 
and  Surg.  Reporter,  of  which  he  was  at  that  time  the  editor. 
The  body  was  then  sewed  up,  but  the  organs,  which  had  been 
removed  in  a mass,  were  preserved  separately,  and  a few 
weeks  afterwards  the  specimen  was  sent  to  this  city,  where  it 
remained  for  a short  time  ; here  it  was  again  examined,  and 
very  recently  the  whole  has  been  returned  to  Nantucket  and 
buried. 


310 


MONSTROSITIES. 


With  regard  to  the  external  appearances,  it  may  be  stated 
that  there  was  no  trace  of  a third  upper  extremity,  and  that 
the  two  spines,  being  traceable  to  the  middle  of  the  back, 
would  probably  have  met  about  at  the  sacrum. 

On  examination  of  the  organs,  there  were  found  two  hearts 
within  a common  pericardium.  One  was  perfectly  normal. 
The  other  was  somewhat  smaller ; consisted  of  a single,  large, 
ventricular  cavity,  from  which  there  arose  an  aorta  of  full  size, 
and  a small  pulmonary  artery,  the  ductus  arteriosus  being  very 
slender ; the  left  auricle  was  very  much  larger  than  the  right, 
the  limits  between  them  being  well  defined,  though  there  was 
only  the  trace  of  a septum.  The  lower  vena  cava  was  com- 
mon to  the  two  organs,  and  divided  just  above  the  diaphragm. 
Each  aorta  gave  off  a large  vessel,  which  immediately  divided, 
and  just  beyond  this  a second,  undoubtedly  the  two  carotids 
and  a subclavian,  the  subclavian  arteries  arising  from  different 
aortas,  as  each  of  the  two  upper  extremities  belonged  to  a 
different  subject.  The  aorta  of  the  largest  heart  passed,  as 
usual,  over  the  corresponding  left  primary  bronchus,  but  the 
other  over  the  right  primary  bronchus  of  the  second  set  of 
lungs,  and  somewhere  between  the  arch  and  the  diaphragm 
the  two  formed  a common  trunk. 

The  respiratory  organs  and  thymus  gland  were  in  double 
sets,  the  lungs  being  small,  irregular,  and  much  fissured,  ex- 
cept the  one  which  corresponded  to  the  malformed  heart,  and 
was  upon  the  right  side. 

The  alimentary  canal,  having  been  washed  out  and  inflated, 
a drawing  was  made  of  it  by  Dr.  Jeffries  Wyman,  and  has 
been  represented  in  Figure  25.  The  two  stomachs  were  well 
formed,  and  one  of  them  was  of  full  size ; the  other  was  about 
half  as  large  as  the  first,  and  buried,  as  it  were,  in  a cavity  in 
the  liver.  The  duodenum  of  each  was  about  three-fourths  of 
an  inch  in  length  ; the  two  then  united  to  form  a single  intes- 
tine, which  was  three  inches  and  a half  in  length,  half  an  inch 
or  more  in  diameter,  and  much  contorted.  Near  the  termina- 
tion of  this  irregular  portion  of  intestine  was  a diverticulum, 
three-fourths  of  an  inch  in  length,  and  adherent  to  the  intes- 
tine, its  cul-de-sac  being  directed  towards  the  great  dilatation, 
into  which  the  intestine  now  opened.  The  dilatation  was  three 
inches  and  a half  in  length  in  a straight  line,  and  one  and  a 


MONSTROSITIES. 


311 


half  inches  in  diameter ; considerably  curved  upon  itself,  and 
upon  its  large  curvature  sacculated,  as  the  large  intestine  of  an 
adult  often  is.  The  dilatation  was  followed  by  ten  inches  of 
small  intestine,  which  arose  quite  abruptly,  and  eight  and  a 
half  inches  of  large  intestine,  besides  what  may  have  been 
left  in  the  body. 

The  liver  was  single  ; lobes  irregular.  One  well  developed 
gall-bladder,  with  its  ducts,  corresponded  to  the  largest  stomach, 
and  near  it  there  was  seen  the  situation  for  the  second,  if  it  had 
existed.  According  to  the  statement  of  Dr.  R.  there  was  one 
spleen  and  two  kidneys.  In  the  mass  examined  here,  there  were 
found  two  rudimentary  spleens  connected  with  the  large  stom- 
ach, and  about  a line  or  more  in  diameter ; one  kidney  with 
its  renal  capsule,  and  a second  renal  capsule  without  its  kidney. 

851.  A double-headed  Lamb.  The  two  heads  are  united  at  an  ob- 
tuse angle,  and  the  central  ears  appear  to  be  fused  at  the  base. 
The  animal  is  otherwise  well  formed,  and,  from  its  size,  may 
have  lived  for  some  time  after  birth.  A stuffed  specimen. 

852.  A double-headed  Kitten.  There  are  no  central  ears,  but  the 
eyes  are  somewhat  far  apart.  A stuffed  specimen. 

853.  A second  specimen,  preserved  in  spirit.  The  central  eyes 
are  not  fused,  though  they  are  in  a common  orbit,  there  being 
two  perfect  sets  of  lids.  1844. 

Mr.  Kimball , Proprietor  of  the  Boston  Museum. 

854.  A double-headed  Chicken.  The  central  eyes  are  probably 
fused,  there  being  but  one  set  of  lids.  The  upper  portion  of 
the  spinal  canal  seems  to  be  open,  as  in  the  next  case. 

855.  A double-headed  Duck ; said  to  have  lived  for  a short  time. 

The  two  heads  form  a more  acute  angle  than  in  the  last  speci- 
men, but  the  central  eyes  are  equally  far  apart.  The  top  of 
the  cranium  may  have  been  injured  by  violence,  but  the  upper 
portion  of  the  spinal  canal  seems  to  be  open,  as  from  conge- 
nital deficiency.  Dr.  J.  B.  S.  Jackson. 

856.  A small  double-headed  Snake,  from  South  America.  The 


312 


MONSTROSITIES. 


two  heads  appear  to  be  equally  developed,  and  form  with  each 
other  a right  angle  as  in  St.  Hilaire’s  figure,  (PL  xv.)  the  cen- 
tral eyes  being  widely  separated. 

Boston  Society  of  Natural  History. 

857.  Cranium  of  a double-headed  Lamb.  The  animal  was  carried 
to  the  full  period,  and  well  formed,  except  for  the  head,  which 
was  sent  to  Dr.  J.  by  Dr.  L.  W.  Briggs,  of  Bristol,  R.  I. 
There  were  two  perfect  eyes,  and  upon  the  median  line  two 
others  which  were  fused,  the  two  cavities  of  the  vitreous 
humor  being  separated  by  a common  sclerotic  coat.  The 
cavity  of  the  mouth  was  single,  and  the  tongue  and  lower  jaw 
showed  no  trace  of  duplication,  in  which  respect  this  specimen 
resembled  one  already  described  (No.  848),  and  differed  from 
what  has  been  generally  observed  in  this  form  of  monstrosity. 
(Hist,  des  Anom.  III.  200.)  The  cranium,  having  been  pre- 
pared, is  seen  to  be  divided  anteriorly  into  two  portions,  which 
are  symmetrical ; each  has  two  frontal  bones,  two  ungues,  one 
nasal  and  intermaxillary,  and  upon  the  outside  a well  devel- 
oped maxillary,  but  upon  the  inside  this  last  is  entirely  want- 
ing ; the  outer  nasal  cavity  is  perfect,  but  the  inner  is  not  so, 
there  being  a deficiency  of  bone  between  the  intermaxillary 
and  os  unguis.  At  the  bottom  of  the  large  common  orbit  are 
seen  the  two  optic  foramina  about  one-third  of  an  inch  apart ; 
superiorly  the  orbit  is  mostly  membranous,  but  inferiorlv  it  is 
in  part  formed  by  an  irregular,  imperfectly  developed,  bony 
plate.  The  posterior  sphenoid,  where  it  is  connected  with  the 
basilar,  is  double,  this  last  and  the  whole  occipital  region  being 
single  and  well  formed.  1846.  Dr.  J.  B.  S.  Jackson. 

858  — 69.  The  following  specimens  may  be  grouped  in  one  series. 

858.  A model  of  Ake,  the  well  known  Chinese  monstrosity  (Hist, 
des  Anom.  PI.  xviii.  Fig.  4) ; sent  to  Dr.  Reynolds  by  a gen- 
tleman in  Canton,  and  with  it  a manuscript  copy  of  Dr.  John 
K.  Mitchell’s  description  of  the  individual  as  observed  by  him- 
self ; the  manuscript  is  deposited  with  the  specimen.  Dr.  M.'s 
description  was  published,  with  an  engraving,  in  the  Philadel- 
phia Journ.  of  the  Med.  and  Phys.  Sciences,  in  1821,  and 
is,  of  course,  much  more  to  be  relied  upon  than  that  of  Dr. 


MONSTROSITIES. 


313 


Livingstone’s  account  of  the  case  which  was  sent  to  England 
from  Canton,  and  has  been  published  in  the  Catalogue  of  the 
Hunterian  Museum,  Dr.  L.  himself  never  having  seen  the 
individual.  It  is  remarkable  that  Dr.  M.’s  description,  which 
is  so  very  full  and  satisfactory,  is  not  mentioned  in  the  Hunt. 
Catalogue,  nor  by  St.  Hilaire.  Dr.  Edward  Reynolds. 

859.  A Kitten,  preserved  in  spirit,  and  showing  two  pairs  of  ex- 
tremities growing  from  about  the  epigastric  region  ; the  ante- 
rior are  united  by  integument  as  far  as  the  carpus,  the  paws 
are  clubbed,  and  there  are  but  four  toes  on  each ; the  posterior 
extremities  are  more  developed,  and  there  is  an  anus  and  some 
appearance  of  genitals,  but  no  tail. 

860.  A stuffed  specimen,  very  similar  to  the  last,  except  that  the 
anterior  extremities  are  not  united. 

861.  A third  specimen  ; preserved  in  spirit,  and  resembles  No.  859, 
except  that  there  is  only  one  pair  of  supernumerary  extremi- 
ties, and  these  are  the  posterior. 

862.  A Chicken  preserved  in  spirit,  and  having  two  supernumerary 
extremities  growing  from  the  back  of  the  pelvis  ; they  are 
not  fully  developed,  and  the  thigh  bones  are  united  by  integu- 
ment. A similar  specimen  has  also  been  sent  to  the  Society 
by  Dr.  Jarvis,  of  Dorchester.  1840.  Dr.  Robert  W.  Hooper . 

863.  The  skeleton  of  a Chicken,  that  resembled  the  last  specimen ; 
mounted.  The  supernumerary  extremities  have  a very  slen- 
der attachment  to  the  coccyx  upon  the  left  side,  but  are  toler- 
ably developed  ; a small,  irregular  bone,  which  represents  the 
pelvis,  being  connected  with  the  upper  extremity  of  the  two 
femora.  Otherwise,  it  is  well  developed.  1847. 

Dr.  D.  H.  Storer. 

864.  A portion  of  the  skeleton  of  a Fowl.  Upon  the  right  side 
there  is  an  additional  ischium,  somewhat  developed,  and  situ- 
ated between  the  sacrum  and  the  true  ischium,  with  which  last 
it  is  fused,  the  sacrum  and  coccyx  being  much  inclined  towards 
the  left  side.  From  this  additional  bone  there  arises  an  ex- 

40 


314 


MONSTROSITIES. 


tremity  which  is  considerably  and  permanently  distorted.  The 
tibia  is  a short,  thick,  stout  bone,  about  one  inch  in  length,  the 
femur  and  metatarsal  bones  being  tolerably  developed ; the 
toes  are  five  in  number,  and  one  of  these  is  bifurcated.  1835. 

Dr.  Winslow  Lewis , Jr. 

865.  Skeleton  of  a Chicken  that  lived  three  months ; mounted. 

The  left  femur,  which  is  formed  by  the  union  of  two,  is  very 
broad,  has  two  distinct  trochanters,  and  terminates  inferiorly  in 
two  extremities,  one  of  which  is  sufficiently  well  developed. 
The  supernumerary  member  has  in  the  place  of  a tibia  and 
fibula  two  bones,  that  look  not  unlike  tibiae,  being  largely 
and  about  equally  developed,  separate  above,  but  soon  becom- 
ing fused,  and  connected  with  the  femur  by  two  additional  and 
distinct  articulating  surfaces ; the  metatarsal  bone  is  short, 
slender,  and  very  much  bent  upon  itself,  and  beneath  it  there 
was  during  life  a considerable  callus,  this  division  of  the  ex- 
tremity being  as  much  or  more  used  in  progression  than  the 
other;  the  whole  terminates  in  three  very  imperfectly  devel- 
oped toes.  In  the  pelvis  there  is  some  appearance  of  duplica- 
tion upon  the  left  side,  but,  otherwise,  the  skeleton  is  well 
formed,  as  were  the  internal  organs,  except  that  the  intestine 
had  four  caeca,  two  of  them  being  large,  one  small,  and  one 
of  intermediate  size.  1840.  Dr.  J.  B.  S.  Jackson. 

866.  The  fore-foot  of  an  adult  Pig ; preserved  in  spirit.  One  of 
the  small  toes  is  normal,  but  in  place  of  the  other  are  two 
large  toes,  giving  altogether  the  appearance  of  a double  foot, 
the  supernumerary,  however,  being  less  developed  than  the 
principal.  Where  the  foot  was  cut  off  there  are  seen  to  be 
five  metatarsal  bones. 

867.  The  hind  feet  of  a young  Pig ; one  has  been  dried,  and  the 
other  prepared  to  show  the  condition  of  the  bones,  the  mal- 
formation being  apparently  the  same  in  both.  In  the  dissected 
specimen,  the  two  principal  toes,  and  the  small  one  upon  the 
outside,  are  perfect  in  all  their  parts ; upon  the  inside  there 
are  two  other  toes,  nearly  as  large  as  the  first  two,  and  con- 
nected with  the  tarsus  by  a single  large  metatarsal  bone  ; be- 
tween these  two  feet,  for  so  they  appear  to  be,  is  a small  un- 


MONSTROSITIES. 


315 


developed  toe,  that  belongs  rather  to  the  supernumerary  foot 
than  to  the  principal.  The  tarsus  has  additional  bones  or 
rather  cartilages  in  connection  with  the  supernumerary  meta- 
tarsal. 

This  specimen,  with  the  following  others,  was  purchased  by 
subscription  amongst  the  members  of  the  Society,  at  the  New 
England  Museum  : — Nos.  537,  636,  824,  825, 839,  840, 845, 
851,  852,  854,  859,  860,  861,  and  866. 

868.  A series  to  show  the  development  of  the  supernumerary 
thumb  so  often  observed  in  the  domestic  Fowl. 

In  the  first  specimen  there  is  a very  imperfectly  developed 
additional  phalanx,  besides  the  terminal  one,  the  nail  only  ap- 
pearing externally.  In  the  next,  the  first  phalanx  of  the  proper 
thumb  bifurcates,  the  additional  phalanges  being  well  devel- 
oped and  directed  upwards  ; these  two  specimens  are  mates, 
as  are  also  the  fourth  and  fifth.  The  third  essentially  resembles 
the  second,  the  fusion  at  the  bifurcation  being  more  complete. 
In  the  fourth  specimen  the  additional  thumb  is  in  all  its  parts 
fully  developed,  curved  upwards,  and  situated  directly  above 
the  principal.  The  fifth  resembles  the  fourth.  In  all  of  these, 
excepting  the  fifth,  the  development  of  the  bones  has  been 
fully  shown  by  removing  the  soft  parts  from  the  under  surface 
of  the  thumb.  The  last  specimen  consists  of  a set  of  bones, 
separated  by  maceration,  and  in  which  the  bone  that  sup- 
ported the  two  thumbs  consists  of  a single  broad  piece.  1845. 

869.  A preparation  to  show  the  development  of  the  bone  in  a su- 
pernumerary thumb  ; there  are  two  phalanges,  connected  by 
fibrous  substance,  the  first  about  two  lines  in  diameter,  the 
second  nearly  an  inch  in  length,  and  supporting  a well  formed 
nail.  It  was  attached  to  the  integuments  over  the  metacarpal 
bone  of  the  thumb,  and  was  removed  as  an  incumbrance,  the 
patient  being  a young  mechanic.  1837. 

Dr.  J.  B.  S.  Jackson. 

870.  A cast  in  plaster  of  the  right  hand  of  a little  girl,  showing  a 
thumb  with  three  phalanges.  The  thumb  is  long  and  slender, 
and  reaches  about  as  far  forwards  as  the  little  finger.  1846. 

Dr.  Benjamin  E.  Cotting,  of  Roxbury. 


316 


MONSTROSITIES. 


871.  Two  Hen’s  eggs,  united  by  a short  thick  band ; they  are  toler- 

ably developed  in  regard  to  size,  though  there  is  only  a trace 
of  shell.  Boston  Society  of  Natural  History. 

872.  A double  Peach,  preserved  in  spirit ; the  two  are  fully  devel- 

oped, and  united  intimately,  though  to  a small  extent,  near  the 
common  stem.  Dr.  J.  B.  S.  Jackson. 

873.  A cast  in  plaster  of  two  Apples,  united  like  the  above. 

Dr.  Henry  1.  Bowditch. 

874.  A cast  in  plaster  of  two  Cucumbers,  that  had  a linear  union 
throughout  almost  their  entire  length ; these  two  casts  were 
taken  by  Dr.  William  E.  Coale.  Dr.  Charles  Bertody. 

hi.  Monstrosities  by  distortion. 

875.  Cranium  of  a Fowl,  showing  a strong  incurvation  of  the  upper 
mandible  to  one  side,  as  in  No.  842. 

Mr.  Charles  K.  Whipple. 

876.  Cranium  of  a Canaiy  bird,  showing  a similar  deformity. 

Dr.  William  T.  Parker. 

877.  A Hen’s  egg,  quite  small,  and  contracted  at  one  extremity,  so 
as  to  resemble  in  form  a certain  kind  of  gourd ; shell  for  the 
most  part  well  developed.  1844. 

Dr.  Benjamin  E.  Cotting,  of  Roxbury. 

878.  Deformity  of  the  lower  extremity ; removed  at  the  hip-joint, 
and  preserved  in  spirit.  The  knee  appears  to  be  dislocated, 
the  head  of  the  tibia  resting  upon  the  outside  of  the  femur ; 
the  leg,  in  the  recent  state,  was  strongly  flexed  upon  the 
thigh,  the  foot  very  strongly  flexed,  and  twisted  so  that  its  inner 
edge  was  in  contact  with  the  leg,  and  its  sole  with  the  thigh, 
the  outer  condyle  being  quite  prominent,  and  forming  the 
proper  termination  of  the  extremity. 

From  a child  that  was  born  with  imperforate  anus,  and  died 
on  the  fifth  day,  being  otherwise  well  formed,  except  for  some 
trifling  deviations  in  the  arteries.  October,  1841. 

Dr.  E.  0.  Phinney. 


PARASITES. 


317 


879.  Cranium  of  a six  months  foetus ; mounted.  There  is  great 
deformity  of  the  vault,  and  such  as  may  possibly  have  been 
caused  by  external  pressure,  the  bones  being  compressed 
laterally,  and  the  right  parietal  doubled  upon  itself ; the  ver- 
tical diameter,  on  the  other  hand,  is  proportionately  increased, 
and  the  whole  occipital  region  much  depressed.  Otherwise 
the  fostus  was  well  developed ; presented  by  the  knees.  The 
mother  has  aborted  several  times  at  the  same  period,  and 
thinks  she  has  a uterine  tumor,  though  none  has  ever  been  dis- 
covered on  examination.  1847.  Dr.  Enoch  Hale. 


XIY.  PARASITES. 

880.  A jar  containing  a large  number  of  lumbrici  (Asc.  lumbri- 
coides.)  The  patient  was  a little  girl,  four  years  old,  and  had 
passed  one  hundred  and  twenty  of  these  worms  within  the 
course  of  a few  weeks,  twenty  being  the  greatest  number 
passed  at  any  one  time.  She  lived  almost  wholly  upon  animal 
food  : appetite  diminished,  but  general  health  sufficiently  good. 

Dr.  D.  H.  Storer. 


881.  Dissection  of  a male  lumbricus.  Dr.  Jeffries  Wyman. 

882.  Lumbricus  from  the  gall-bladder  of  a man  who  died  of  acute 

dysentery.  Nov.  1836.  Mass.  Gen.  Hospital. 

883.  Intestinal  worms  (Asc.  marginata,  Lamarck)  from  a young 
dog.  The  animal  was  found  in  the  road  in  a fit,  and  carried 
into  the  house  of  a physician,  where  he  was  kept  under  obser- 
vation for  three  days  and  then  drowned.  The  paroxysms  fre- 
quently recurred,  though  lasting  but  a few  minutes  at  a time  ; 
they  began  with  a twitching  of  the  face,  then  the  left  side,  and 
at  last  the  whole  body  being  affected  ; after  the  convulsions  he 
appeared  for  a time  quite  delirious.  On  the  most  careful  ex- 
amination of  all  the  organs  of  the  abdomen,  thorax  and  head, 
no  disease  was  discovered,  but,  about  the  middle  of  the  small 
intestine,  five  worms  were  found  coiled  up  in  a knot,  and 


318 


PARASITES. 


measuring  from  three  and  a half  to  seven  and  a half  inches  in 
length.  Dr.  Jeffries  Wyman. 

884.  A Guinea-worm,  (Filaria  med.)  nine  and  a half  inches  in 

length;  removed  from  the  integuments  of  the  abdomen,  where 
it  had  caused  much  local  inflammation.  The  patient  was  a 
sailor,  and  had  been  troubled  by  the  worm  since  he  was  on  the 
coast  of  Africa  about  a year  before  ; he  had  also  another  re- 
moved from  the  foot.  Dr.  Charles  H.  Stedman. 

885.  A portion  of  the  lung  of  a Porpoise  (Phoc.  communis,)  con- 

taining Filariae,  great  numbers  being  found  in  the  air-passages, 
or  in  the  fluid  which  had  drained  from  them  (No.  886.)  They 
were  generally  about  one  inch  and  a half  in  length.  Ascari- 
des  were  also  found  in  the  stomach.  The  animal  was  har- 
pooned off  Nahant,  and  the  organs  were  sent  here  for  dissec- 
tion by  Mr.  William  H.  Johnson , of  Nahant. 

886.  Filariae  from  the  air-tubes  of  a Porpoise  (No.  885.) 

887.  Several  worms,  probably  Filariae,  from  the  peritoneal  cavity 
of  a Horse  ; they  are  about  three  and  a half  inches  in  length, 
quite  attenuated  at  one  extremity,  blunt  at  the  other,  and  with- 
out any  appearance  of  papillae.  A similar  specimen  has  been 
also  presented  by  Dr.  H.  I.  Bowditch. 

Dr.  Morrill  Wyman , of  Cambridge. 

888.  A portion  of  the  parietes  of  the  abdomen  of  a Sculpin,  in 
which  were  found  a considerable  number  of  worms,  probably 
Filariae ; they  are  half  an  inch  or  more  in  length,  and  were 
coiled  up  beneath  the  peritoneum,  which  has  been  removed  to 
expose  them,  one  being  still  covered  by  the  membrane.  1845. 

Dr.  Jeffries  Wyman. 

889.  Strongylus  gigas ; six  specimens  from  the  kidney  of  a Mink 
(No.  598)  ; length  from  nine  to  twenty-one  inches. 

Dr.  Erasmus  D.  Miller , of  Dorchester. 

890.  Several  parasites  (Echinorynchus  gigas)  attached  to  the  in- 
testine of  a Hog,  with  depressions  in  the  mucous  membrane 


PARASITES. 


319 


showing  where  others  have  been  attached,  and  a thickening  of 
the  corresponding  portion  of  the  intestine  externally. 

Dr.  Jeffries  Wyman. 

891.  One  of  the  parasites  (No.  890,)  in  a separate  phial ; they  are 
generally  about  five  inches  in  length. 

892.  A portion  of  intestine  from  a Striped  Basse  (Labrax  lineatus,) 

with  numerous  Echinorynchi  attached,  several  of  them  having 
perforated  the  parietes.  1845.  Dr.  Jeffries  Wyman. 

893-900.  Eleven  specimens  of  Taenia  solium  from  the  human  sub- 
ject are  in  the  Cabinet,  of  which  the  following  may  be  noticed. 

893.  The  first  is  six  feet  in  length.  The  patient  was  a gentleman, 

about  twenty-five  years  of  age,  and  had  been  in  Canton  for 
several  years,  when  he  began  to  pass  fragments  of  the  worm  ; 
this  happened  frequently,  and  also  for  a considerable  time  after 
his  return  to  this  country,  when,  under  the  use  of  turpentine, 
preceded  by  a rigid  diet  and  an  active  cathartic,  the  worm  was 
expelled,  and  he  has  passed  none  since,  twenty  months  having 
now  elapsed.  1843.  Dr.  Charles  G.  Putnam. 

894.  The  second  specimen  is  much  broken,  but  the  fragments 

altogether  measure  several  feet  in  length.  The  joints  are  very 
regular,  but  vary  much  in  size  and  form ; some  are  quite 
remarkable  for  their  shortness,  and  for  the  union  between 
them  being  almost  confined  to  the  median  line,  as  shown  in 
a drawing  by  Dr.  Wyman.  The  patient  was  a little  girl,  nine 
years  old,  who  had  been  sick  for  about  a year,  having  pre- 
viously enjoyed  good  health ; her  symptoms  were  loss  of  flesh 
and  strength,  with  an  enlarged  abdomen,  and  very  strong  ap- 
petite. Having  taken  a common  cathartic,  some  joints  of  the 
worm  came  away  ; an  active  cathartic  was  then  given,  and  the* 
whole  was  expelled,  when  she  at  once  regained  her  health. 
1843.  Dr.  James  B.  Forsyth , of  Chelsea. 

895. '  The  third  specimen  is  remarkable  for  the  great  irregularity  in 
the  form  of  many  of  the  joints,  for  having  many  of  the  lateral 
pores  successively  upon  the  same  side,  and  for  being  the  only 


320 


PARASITES. 


one  in  the  Cabinet  from  the  human  subject  in  which  the  head 
is  to  be  seen ; this  last,  as  it  appeared  under  the  microscope, 
has  been  figured  by  Dr.  Jeffries  Wyman.  The  patient  was 
a man  about  forty  years  of  age,  and  the  worm  was  expelled 
without  medicine.  1843.  Dr.  John  Homans. 

896.  A portion  of  the  above  specimen,  showing  the  remarkable 
irregularity  of  some  of  the  joints  (Fig.  26.) 

897.  A fourth  specimen,  from  a middle-aged  woman  who  had  been 
complaining  for  four  or  five  years ; discharged  after  a dose 
of  turpentine  ; a few  months  afterwards  she  died  of  phthisis. 

Dr.  M.  S.  Perry. 

898.  A fifth  specimen,  nearly  thirty-two  feet  in  length. 

Dr.  D.  H.  Storer. 

899.  A portion  of  Taenia  solium  dried  upon  glass,  to  show  the  ge- 
nital apparatus. 

900.  Several  specimens  of  Taenia  from  a Porcupine  (Hystrix  dor- 
sata.)  They  are  mostly  about  one  inch  and  a quarter  in 
length  ; anterior  extremity  pointed,  with  a well  marked  head, 
but  without  any  appearance  of  hooks ; the  posterior  extrem- 
ity being  broad,  thick  and  quite  blunt,  as  shown  in  a drawing 
by  Dr.  Wyman.  The  joints  are  very  short,  and  the  pores  are 
sometimes  seen  not  merely  upon  the  same  side  of  several  suc- 
cessive joints,  but  occasionally  upon  both  sides  or  edges  of  the 
same  joint.  A few  of  the  specimens  are  longer  than  the  above, 
more  uniformly  narrow  and  thin,  and  have  but  very  few  lateral 
pores.  This  is  the  second  instance  in  which  Dr.  W.  has  found 
a large  collection  of  these  parasites  in  the  Porcupine.  1845. 

Dr.  Jeffries  Wyman. 

901.  A specimen  of  Bothriocephalus,  or  Taenia  lata,  as  it  is  usually 
called.  It  is  seven  feet  in  length,  and  is  about  one-half  of 
what  was  discharged.  The  patient  was  a healthy,  middle- 
aged  Englishman,  and  the  case  occurred  during  the  last  winter 
at  Richmond,  Va.  The  pores  are  seen  upon  the  flat  surface 
of  the  joints,  and  not  upon  the  edges,  as  in  the  taenia  solium ; 


PARASITES. 


321 


and,  a portion  of  the  worm  having  been  dried  upon  glass,  the 
outline  of  the  genital  organs  is  very  distinct.  1847. 

Dr.  Jeffries  Wyman. 

902.  A portion  of  the  above  parasite  dried  upon  glass. 

903.  A second  specimen  of  Bothryocephalus,  three  feet  in  length, 
and  from  half  a line  to  one  line  and  a quarter  in  width ; from 
an  infant.  The  joints  are  very  regular,  except  at  one  extrem- 
ity, where  they  approach  the  triangular  form,  are  very  delicate, 
and  but  slightly  connected,  as  shown  in  a drawing  by  Dr. 
Wyman.  From  a very  healthy  infant  nineteen  months  old; 
it  had  been  weaned  about  six  months,  and  had  had  the  usual 
diet  from  that  time  ; the  worm  was  discharged  without  medi- 
cine, its  presence  having  never  been  suspected.  1842. 

Dr.  Ezra  Palmer , Jr. 

904.  Cysticercus  cellulosee.  From  a woman  about  fifty  years  of 

age,  who  died  of  phthisis  ; a dissecting-room  subject,  at  Rich- 
mond, Va.  In  the  phial  are  contained  a piece  of  muscle  with 
the  cyst  in  it ; secondly  a detached  cyst,  and  thirdly  one  of  the 
parasites  removed  from  its  cyst.  Accompanying  the  specimen 
is  a drawing  by  Dr.  W.  of  the  parasite,  &c.,  as  it  appeared  in 
the  recent  state  under  the  microscope.  About  a dozen  or  fif- 
teen of  the  cysts  were  found  in  the  cellular  membrane  of  the 
muscles  and  in  the  integuments,  besides  one  which  hung  free 
from  the  inner  surface  of  the  dura  mater  near  the  crista  galli. 
In  the  same  subject  there  were  also  numerous  specimens  of 
trichina  spiralis.  1845.  Dr.  Jeffries  Wyman. 

905.  Cysticercus  from  the  mesentery  of  a Sheep.  1840. 

Dr.  Jeffries  Wyman. 

906.  A Linguatula  from  the  intestine  of  an  African  Serpent  (Ce- 
rastes — ) which  was  sent  to  the  Soc.  of  Nat.  History,  by  Dr. 
Thomas  S.  Savage,  of  Cape  Palmas,  the  individual  having  been 
dissected  by  Dr.  S.  There  were  also  sent  several  specimens 
of  the  parasite,  all  of  them  females,  and  from  three  and  a 
half  to  four  inches  in  length. 

Boston  Society  of  Natural  History. 


41 


322 


PARASITES. 


907.  Linguatulae  from  the  inner  surface  of  the  lung  of  a South 
American  Boa.  There  were  altogether  four  or  five  ; one  of 
them,  a female,  was  three  and  a half  inches  in  length ; the 
rest  were  males,  and  did  not  exceed  one  inch  and  a half. 
This  and  the  last  specimen  have  been  figured  and  fully  de- 
scribed by  Dr.  W.  in  the  Journal  of  the  Boston  Soc.  of  Nat. 
History  (Vol.  Y.  No.  2 — 1845.)  Dr.  Jeffries  Wyman. 

908.  Entozoa  from  the  gall-ducts  of  a young  East-Indian  Elephant, 

that  died  in  this  city.  They  are  of  two  kinds,  the  Distoma 
hepaticum,  and  a small  species  of  Ascaris ; immense  numbers 
were  found  in  the  ducts,  and  of  the  ascarides,  a few  were 
found  in  the  duodenum.  In  the  same  jar  are  several  larvae 
from  the  stomach  and  duodenum.  There  was  ascites,  with 
disease  of  the  liver,  and  in  the  stomach  near  the  pylorus 
a large,  deep,  chronic  ulcer,  of  a circular  form  and  perfectly 
defined.  1835.  Dr.  J.  B.  S.  Jackson. 

909.  Trichina  spiralis.  A portion  of  one  of  the  voluntary  mus- 
cles has  been  picked  apart,  so  as  to  form  a thin  extended 
sheet ; having  then  been  dried  and  varnished,  it  is  seen  to  be 
filled  with  the  cysts,  and  with  the  microscope  the  parasite  itself 
may  be  shown.  From  a middle-aged  man,  a patient  of  Dr. 
M.  S.  Perry,  who  died  of  malignant  disease  of  the  abdomen. 
This  case  was  published  by  Dr.  Henry  I.  Bowditch,  in  a full 
paper  upon  the  subject,  and  accompanied  with  drawings,  in  the 
Boston  Med.  and  Surg.  Journ.,  March  30,  1842.  Several 
other  instances  have  been  observed  here,  and  also  in  Kichmond, 
Va.,  by  Dr.  Jeffries  Wyman,  and  one  deserves  especial  notice, 
in  which  Dr.  W.  found  one  or  two  of  the  parasites  about  the 
middle  of  the  oesophagus. 

910.  Small  crustacean  parasites  (Chondracanthus)  from  the  mouth 
of  the  Whiting  (Merlucius  albidus) ; from  Cape  Cod.  1S47. 

Dr.  Jeffries  Wyman. 

911.  Larvre  of  the  Bot-fly  (CEstrus  equi)  from  the  stomach  of  a 

Horse.  Dr.  Morrill  Wyman,  of  Cambridge. 

912.  Larvse  of  the  Bot-fly  (CEstrus  ovis)  from  the  frontal  sinuses  of 


MISCELLANEOUS  SPECIMENS. 


323 


a Sheep.  Dr.  W.  has  met  with  them  frequently  in  this  situa- 
tion in  the  month  of  February,  when  preparing  for  his  anatom- 
ical lectures  at  Richmond,  Va.  1847. 

Dr.  Jeffries  Wyman. 


XV.  MISCELLANEOUS  SPECIMENS. 

913.  Chinese  Paintings. 

A collection  of  twenty-eight  highly  finished  oil  paintings, 
that  were  presented  to  the  Society  by  Dr.  Robert  W.  Hooper, 
April  14,  1845.  They  were  executed  by  a native  artist  at  the 
hospital  in  Canton,  under  the  charge  of  Dr.  Peter  Parker,  and 
represent  various  forms  of  external  disease,  but  chiefly  tumors  ; 
many  of  these  are  of  great  size,  and  this  development  of  the 
diseased  masses  is  one  of  the  most  striking  features  in  the 
collection,  as  was  shown  in  an  article  by  Dr.  Holmes  in  the 
Boston  Med.  and  Surg.  Journ.,  May  21,  1845.  The  healthy 
appearance  of  most  of  the  subjects  is  also  remarkable,  for, 
as  in  Alibert’s  plates  of  the  skin,  the  individual  is  repre- 
sented as  fully  as  the  disease.  A descriptive  catalogue  of 
most  of  the  cases  has  also  been  presented  to  the  Society  with 
the  paintings ; copied  from  the  Reports  of  the  Plospital,  which 
were  published  in  the  Chinese  Repository. 

914.  Three  drawings  in  water  colors,  admirably  executed,  and 
representing  different  views  of  a malignant  tumor  of  immense 
size  that  formed  about  the  shoulder.  They  were  taken  by  a 
professed  artist,  Mr.  J.  R.  Penniman,  for  Dr.  John  Homans,  in 
whose  practice  the  case  occurred,  and  were  presented  by  him 
to  the  Society,  with  a full  history  of  the  case. 

The  patient  died  in  June,  1831,  aged  fifty-four  years.  In 
August,  1816,  he  fell,  and  broke  the  left  humerus  just  below 
the  shoulder  joint.  Union  took  place,  but  in  the  winter  he  be- 
gan to  have  pain,  and  in  the  course  of  the  following  year  a 
tumor  appeared  in  the  axilla.  This  tumor  gradually  increased, 
and  in  1825  was  as  large  as  the  head  of  a child  of  six 
months.  In  the  autumn  of  1829  the  growth  became  more 
rapid ; his  health,  which  had  previously  been  perfectly  good, 
began  to  fail,  and  he  gave  up  his  business  as  a stage-driver, 


324 


MISCELLANEOUS  SPECIMENS. 


which  until  that  time  he  had  pursued  regularly  ; in  the  spring, 
however,  he  resumed  his  occupation,  and  continued  it  until  the 
autumn,  from  which  time  the  enlargement  of  the  tumor  and 
the  failure  of  his  health  went  on  rapidly.  A few  weeks  before 
death,  sloughing  commenced,  profuse  discharge  followed,  with 
severe  pain,  and  the  tumor  diminished  greatly  in  size. 

The  tumor  extended,  as  shown  in  the  drawings,  from  the  top 
of  the  shoulder  nearly  to  the  ilium,  and  from  the  anterior  ex- 
tremity of  the  ribs  to  the  base  of  the  scapula,  the  upper  half 
of  the  humerus  being  also  involved  ; weighed  sixty-two  pounds, 
with  the  scapula  and  clavicle,  after  being  dissected  from  the 
arm.  “ The  only  attachment  to  the  body  was  by  condensed 
cellular  tissue  ; the  mass  itself  consisted  mainly  of  a sort  of 
cartilaginous  substance,  whilst  other  portions  were  very  soft, 
and  the  whole  was  held  together  by  fibrous  membrane.”  1844. 

915.  A collection  of  thirty-two  casts  in  plaster,  representing  dislo- 
cations, fractures,  deformities  of  the  feet,  and  some  other  cases 
of  external  disease  ; presented  to  the  Society  by  Dr.  Nathan 
R.  Smith,  of  Baltimore,  through  his  colleague,  Dr.  Joseph 
Roby,  the  original  moulds  having  been  made  by  Dr.  S., 
March  23,  1846. 

916.  An  adipose  tumor,  about  three  inches  in  diameter. 

Dr.  A.  L.  Peirson , of  Salem. 

917-8.  Two  other  specimens  of  the  same. 

Dr.  S.  D.  Townsend. 

919.  A large,  glandular  tumor,  removed  from  the  axilla.  The  pa- 
tient was  a lad,  thirteen  years  of  age,  and  otherwise  quite 
healthy.  The  tumor  had  existed  for  a year,  and  weighed 
nearly  two  pounds  after  its  removal,  the  skin  being  much  dis- 
colored, with  enlargement  of  the  veins ; external  surface  lobu- 
lated,  and  internally  it  consisted  of  a firm,  whitish,  nearly  uni- 
form structure.  The  boy  recovered.  Dr.  S.  D.  Townsend. 

920.  A “ scirrhous  tumor  ” removed  from  under  the  pectoral  mus- 
cle. It  is  of  a flattened,  oval  form,  about  the  size  of  a small 
orange,  somewhat  irregular  upon  the  surface,  and  having  a 


MISCELLANEOUS  SPECIMENS. 


325 


uniform,  dense,  whitish  structure,  as  shown  on  incision.  The 
patient  was  a middle-aged  female,  and  had  been  aware  of  the 
existence  of  the  tumor  for  four  months  previously  to  the  opera- 
tion, during  which  time  it  had  grown  rapidly,  but  without  pain. 
In  the  operation  it  was  readily  detached,  the  pectoral  muscle 
not  being  involved  ; no  disease  existed  in  the  breasts,  but  there 
was  some  enlargement  of  the  axillary  glands. 

Dr.  George  Hayward. 

921.  A cellular  tumor  removed  by  Dr.  L. ; the  patient  was  a fe- 
male, thirty-four  years  of  age,  and  did  well,  though  in  the 
seventh  month  of  pregnancy  when  the  operation  was  per- 
formed. The  mass  hung  pendulous  from  behind  the  knee, 
and  weighed  about  thirteen  pounds ; it  had  been  forming  for 
about  eleven  years,  and  had  begun  to  ulcerate,  but  was  not 
painful.  Internally  it  is  seen  to  consist  of  a coarse,  cellular 
structure,  some  of  the  cells  being  as  large  as  a hazel-nut,  and 
filled,  when  recent,  with  a thin,  ropy  fluid. 

Dr.  Winslow  Leivis,  Jr. 

922.  An  encysted  tumor  from  the  scalp ; size  of  an  English 

walnut.  Dr.  S.  D.  Townsend. 

923.  Four  encysted  tumors  from  the  scalp  ; from  the  size  of  a pea 

to  that  of  a nutmeg.  Dr.  S.  D.  Townsend. 

924.  A cyst  removed  from  the  outer  edge  of  the  orbit.  The  pa- 
tient was  a young  woman,  and  the  tumor  had  been  observed  in 
infancy ; gradually  increased  in  size,  but  for  the  last  three 
years  had  grown  more  rapidly.  When  removed,  it  was  about 
the  size  of  a filbert,  and  contained  an  oily  fluid,  in  which  were 
short,  stiff  hairs,  resembling  those  of  the  eyebrow.  The  cyst 
has  been  dried,  and  many  of  the  hairs  are  seen  to  adhere  to 
the  interior  of  the  cyst,  though  they  are  mostly  free.  1843. 

Dr.  Robert  W.  Hooper. 

925.  Hair  discharged  from  the  umbilicus.  The  patient,  a middle- 
aged  female,  had  had  pain  and  tenderness  in  the  part  for 
nearly  two  years,  and  for  some  months  a fistulous  opening ; 
two  other  small  pellets  of  hair  were  discharged  about  the  same 
time,  and  the  opening  then  closed.  Dr.  Edward  Reynolds. 


326 


MISCELLANEOUS  SPECIMENS. 


926.  Cancerous  disease  of  the  thigh,  removed  by  excision.  The 

patient  was  a female,  about  sixty  years  of  age.  For  ten  years 
or  more  she  had  had  a small,  indolent,  subcutaneous  tumor, 
that  for  the  last  two  years  had  become  painful,  and  resulted, 
at  last,  in  a deep,  cancerous  ulceration  about  an  inch  in  diam- 
eter. The  wound  healed  in  about  a week,  but  the  disease  re- 
appeared in  the  same  place,  and  the  patient  died  six  weeks 
after  the  operation,  the  inguinal  glands  having  become  diseased, 
and  also  those  in  the  abdomen.  Dr.  M.  S.  Perry. 

927.  Enlargement,  with  induration  of  the  thymus  gland.  The  pa- 
tient was  a stout,  fleshy  woman,  sixty  years  of  age,  and  had 
suffered  somewhat  from  dyspnasa  with  febrile  symptoms  for 
three  or  four  months  before  death. 

Dr.  Winslow  Lewis , Jr. 

928.  A Frog,  which  was  found  at  Mount  Auburn,  in  good  condi- 
tion, and  quite  active  in  all  its  motions.  It  had  lost  the  greater 
part  of  one  of  the  posterior  extremities,  and  shows  a most  per- 
fectly formed  stump.  Another  was  some  time  afterwards 
found  by  Dr.  W.,  which  had  lost  the  leg  below  the  knee,  the 
stump  in  this  case  being  equally  perfect. 

Dr.  Jeffries  Wyman. 

929.  A Frog,  showing  the  entire  loss  of  one  of  the  anterior  ex- 
tremities ; from  the  gardens  at  Versailles.  1844. 

Dr.  Jeffries  Wyman. 

930.  A cast  in  plaster  of  the  stump  after  a sloughing  off  of  the 
leg  below  the  knee.  This  case  occurred  about  six  years  since 
in  a miserable  Irish  family,  and  during  a severely  cold  winter. 
The  patient,  a little  girl,  eleven  years  of  age,  was  attacked  with 
purpura,  and  the  effusion  of  blood  being  very  extensive,  hemi- 
plegia came  on,  and  the  paralyzed  limb  mortified,  having  been 
frozen,  as  it  was  supposed,  without  the  knowledge  of  the  child ; 
in  a year  or  more  it  was  separated  by  the  natural  processes. 
A conspicuous  object  in  the  cast  is  an  enlarged  bursa  over  the 
patella,  but  this  has  since  disappeared.  1842. 

Dr.  William  E.  Coale. 


MISCELLANEOUS  SPECIMENS. 


327 


931.  A small  Lizard  (Anolis  — Cuv.)  from  Surinam,  showing  a 

bifid  condition  of  the  tail  about  midway ; the  two  form  a very 
acute  angle,  and  the  additional  one,  which  seems  to  contain  no 
bone,  is  rather  shorter  and  smaller  than  the  principal.  This 
was  the  result  probably  of  a wound,  and  the  tendency  which 
there  is  in  these  reptiles  to  reproduce  the  part  when  lost  by  ac- 
cident. 1839.  Boston  Society  of  Natural  History. 

932.  A piece  of  bone  from  the  fat  about  the  kidney  of  a Hog ; it  is 

five  inches  in  length,  from  nine  to  fifteen  lines  in  width,  and 
from  two  to  three  lines  in  thickness  ; the  surfaces  are  smooth, 
but  the  edges  are  quite  irregular,  and  the  structure  is  rather 
light.  1843.  Dr.  Nathaniel  B.  Shurtleff. 

933.  A rough,  three-cornered  piece  of  stone,  about  half  an  inch  in 
diameter,  removed  from  the  integuments  beneath  the  jaw. 
The  patient  was  a laboring  man,  and  had  been  blown  up  about 
two  years  befoi'e,  whilst  blasting  rocks  ; several  pieces  of  stone 
were  driven  into  the  flesh,  and  all  of  them  had  been  removed 
excepting  the  one  in  the  neck,  which  he  had  allowed  to  remain, 
as  it  never  troubled  him,  the  parts  about  it  being  much  con- 
densed. 

934.  A phial,  containing  several  pieces  of  bone  that,  with  a great 
many  more,  were  said  to  have  been  discharged  from  the  nose 
and  ear.  The  pretended  sufferer  was  an  intelligent  and  inter- 
esting little  girl,  eleven  years  of  age,  and  the  deception  was 
carried  on  for  several  months,  while  under  various  methods  of 
treatment. 

935.  Hands  of  a Guanche  Indian,  from  the  Isle  of  Teneriffe  ; they 
are  clasped  together,  and  dried  in  this  position,  with  the  flesh 
on,  the  bones  of  the  fore-arm  being  preservecLin  connection. 
The  size  is  not  remarkable. 

Boston  Society  of  Natural  History. 

936.  Fore-arm  and  hand  of  an  Egyptian  Mummy;  the  flesh  is  dried 
on,  and  remarkably  well  preserved  ; the  subject  was  a child. 
Also  the  fore-arm  of  an  older  subject,  in  the  same  condition. 

Francis  C.  Lowell,  Esq. 


APPENDIX. 


Of  the  following  specimens,  four  were  accidentally  omitted  in 
preparing  the  Catalogue,  and  the  rest  were  received  too  late  for  in- 
sertion in  their  proper  place. 

937.  Extensive  and  deep  absorption  of  the  bodies  of  three  of  the 

dorsal  vertebra,  upon  the  left  side ; the  result  of  an  aneurism. 
A larger  sac  existed  at  the  arch  of  the  aorta,  that  had  de- 
stroyed the  upper  portion  of  the  sternum,  and  formed  a prom- 
inent tumor  externally,  when  first  seen  more  than  two  years  and 
a half  before  death.  The  patient  was  a laboring  man,  forty- 
four  years  of  age,  and  was  in  the  habit  of  wearing  a copper 
plate  over  the  tumor,  to  protect  it  from  external  injury  when  at 
work ; he  was  once  exhibited  to  the  Society,  and  his  case  was 
published  in  detail  in  the  New  England  Quarterly  Journ.  of 
Med.  and  Surg.,  Oct.  1842.  Dr.  M.  S.  Perry. 

938.  An  old  and  extensive  fracture  of  the  crest  of  the  ilium ; the 

union  is  strong  and  regular,  but  there  is  a considerable  deposit 
of  new  bone  upon  both  surfaces.  From  an  Irish  laborer,  who 
had  been  at  work  upon  one  of  the  railroads,  and  died  probably 
in  a drunken  affray.  1847.  Mr.  Calvin  Ellis. 

939.  Bony  anchylosis  of  the  hip-joint,  the  femur  being  bent  to  about 
a right  angle  with  the  trunk.  The  union  is  strong,  though  a 
considerable  opening  is  seen  through  the  ischium.  From  a 
middle-aged  man,  who  had  an  attack  of  apoplexy  in  the  street 
in  New  York ; was  carried  into  a Hospital,  and  died  soon  after 
entrance.  Presented  to  the  Society,  June,  1847,  by 

Dr.  William  T.  Thurston , of  St.  Kitts,  W.  I. 


APPENDIX. 


329 


940.  Extensive  caries  of  the  knee-joint,  with  an  abundant  deposit 
of  new  bone  about  the  articular  surface  of  the  femur.  The 
following  is  an  abstract  of  a full  history  of  the  case,  that  was 
given  by  Mr.  Edwin  Leigh,  a student  of  medicine.  The  pa- 
tient was  a carpenter,  fifty-three  years  of  age  ; general  health 
good,  and  habits  always  temperate.  In  the  year  1822  he 
wounded  the  right  knee-joint  with  an  axe,  upon  the  inside  of 
the  patella,  and  severe  inflammation  followed,  which  confined 
him  for  three  months  or  more.  For  nearly  a year,  the  knee 
remained  permanently  flexed,  but,  after  an  accidental  fall,  by 
which  the  adhesions  seemed  to  have  been  broken  up,  the  mo- 
tions became  very  much  more  free  ; it  was,  however,  occa- 
sionally troublesome,  and  the  patient  was  always  more  or  less 
lame,  there  being  much  deformity  of  the  joint,  and  in  the  situ- 
ation of  the  wound  a hard  tumor  as  large  as  “ half  an  orange.” 

March  16,  1847,  the  same  knee  was  again  cut  in  the  same 
place  with  a broad-axe.  The  wound  bled  freely,  was  tightly 
bandaged,  and  the  patient  walked  home,  half  a mile.  His 
physician,  Dr.  Charles  F.  Chaplin,  of  Cambridgeport,  being 
called  to  visit  him,  passed  a probe  through  a thick  mass  of 
condensed  cellular  tissue,  and  into  the  joint.  The  accident 
was  followed  at  once  by  very  severe  inflammation  of  the  joint 
and  neighboring  soft  parts ; the  suppuration  was  abundant,  and 
he  became  so  exceedingly  reduced  that  it  was  thought  hardly 
possible  for  him  to  survive  an  amputation.  On  the  13th  of 
June,  however,  the  limb  was  removed  by  Dr.  Lewis,  at  the  up- 
per third  of  the  thigh,  the  patient  having  first  been  put  under 
the  influence  of  ether ; immediately  after  the  operation  he  be- 
gan to  rally,  and  from  that  time  rapidly  improved,  so  that  about 
the  middle  of  July  he  was  able  to  go  out,  and  his  health  is 
now  fully  restored. 

On  dissection  of  the  limb,  which  for  one  or  two  days  re- 
tained the  odor  of  the  ether,  very  extensive  abscesses  were 
found  above  the  knee,  having  upon  the  inner  surface  a dark, 
gangrenous  appearance,  and  communicating  freely  with  the 
joint ; below  the  knee,  they  were  less  extensive.  The  inside 
of  the  joint,  for  the  most  part,  resembled  the  abscesses  in  its 
dark,  shreddy  appearance,  the  bone  being  denuded  and  rough, 
and  only  a trace  of  cartilage  remaining.  Between  the  patella 
and  the  anterior  portion  of  the  femur,  however,  there  were  old 
42 


330 


APPENDIX. 


cellular  adhesions,  probably  the  result  of  the  first  injury,  and 
to  this  part  of  the  joint  the  recent  inflammation  did  not  extend, 
the  outline  of  the  two  portions  being  quite  marked  in  the  pre- 
pared specimen.  Sept.  1,  1847.  Dr.  Winslow  Lewis,  Jr. 

941.  Section  of  an  anchylosed  knee-joint.  (See  next  specimen.) 

Dr.  Charles  F.  Heywood. 

942.  Disease  of  the  tibia,  the  result  of  necrosis.  The  patient  was 
a physician,  fifty  years  of  age,  and  entered  the  Massachusetts 
General  Hospital  May  31,  1847.  When  he  was  ten  years  old 
a large  abscess  formed  in  consequence  of  an  injury  of  the  leg ; 
in  two  months  the  bone  began  to  exfoliate,  and  in  the  course 
of  a year  he  thinks  the  whole  of  the  tibia  came  away,  ex- 
cepting the  epiphyses.  In  five  or  six  years  the  openings 
closed,  and  he  had  a useful  limb,  except  for  an  anchylosis  of 
the  knee  and  ancle-joints,  his  general  health  being  good.  Four 
years  ago,  as  he  stated  on  admission,  the  surface  was  abraded 
just  above  the  ancle,  and  an  ulcer  formed,  which  never  after- 
wards healed ; fourteen  months  ago,  dead  bone  began  to  be 
discharged  from  the  ulcerated  surface,  and  for  the  last  eight 
months  the  leg  had  been  exceedingly  painful  with  much  loss 
of  flesh  and  strength. 

The  above  is  an  abstract  of  the  case  from  the  records  of  the 
hospital.  On  examination,  a large  ulcer  was  found  to  occupy 
the  lower  anterior  half  of  the  leg,  the  bone  being  exposed, 
and  the  surface  surrounded  by  a peculiar  fungous  growth.  On 
the  5th  of  June  the  thigh  was  amputated  by  Dr.  S.  D.  Town- 
send, and  on  the  4th  of  July  the  patient  died,  having  gradually 
sunk  from  the  time  of  the  operation.  The  stump  had  healed 
perfectly,  but  there  was  found,  on  dissection,  a separation  of 
the  periosteum  about  the  end  of  the  bone,  with  some  small  ab- 
scesses, and  an  inflammation  of  the  femoral  vein. 

The  bones  having  been  prepared  by  Dr.  Heywood,  the 
house-surgeon  of  the  hospital,  the  tibia  is  seen  to  be  much  en- 
larged, and  its  lower  portion  occupied  by  a large  and  very 
irregular  cavity,  the  structure  of  the  bone  being  much  altered. 
The  lower  extremity  of  the  fibula,  and  the  astragalus  and  os 
calcis  are  firmly  anchylosed  with  the  tibia.  Complete  bony 
anchylosis  of  the  knee-joint  also  existed,  except  for  the  central 


APPENDIX. 


331 


opening  which  so  often  exists ; and,  through  this  opening  a 
longitudinal  section  of  the  bones  has  been  made,  the  tibia 
having  first  been  sawed  across  below  the  joint. 

Dr.  Charles  F.  Heywood. 

943.  Melanosis  of  the  eye  (Fig.  36.)  An  account  of  this  case, 
and  of  another  of  colloid  tumor  of  the  orbit,  was  published  by 
Dr.  Bethune,  with  remarks,  in  the  Boston  Med.  and  Surg. 
Journal,  July  28,  1847  ; it  was  accompanied  with  a lithographic 
drawing  of  the  specimen,  and,  by  the  permission  of  Dr.  B., 
the  stone  has  been  used  for  the  present  volume. 

The  following  is  an  abstract  of  the  case  : Mrs.  G.,  forty- 

three  years  of  age,  entered  the  Massachusetts  Eye  and  Ear 
Infirmary,  June  9,  1847,  with  disease  of  the  right  eye.  In 
the  autumn  of  1842,  after  an  exposure,  she  began  to  have  pain 
and  redness  in  the  eye,  with  gradual  loss  of  sight,  which  at  the 
end  of  three  months,  became  total.  Pain  occasionally  re- 
curred, and  at  one  time  the  operation  for  cataract  was  per- 
formed, this  being  followed  by  severe  inflammation,  which 
never  entirely  subsided.  About  eight  or  nine  months  before 
her  admission  she  perceived  a “ sore  place  ” in  the  centre  of 
the  ball,  and  a few  months  afterwards  the  eye  began  to  project 
at  this  point,  and  the  projection  constantly  increased  from  that 
time  ; during  the  last  winter  there  were  frequent  darting  pains 
through  the  eye.  On  admission,  the  anterior  half  of  the  globe 
projected,  in  the  form  of  an  irregular  fungous  mass,  to  the  ex- 
tent of  half  an  inch  through  the  lids  ; in  front,  it  was  of  a car- 
tilaginous hardness,  and  of  a mixed  white  and  red  color ; be- 
hind this  the  color  was  red  and  black,  and  still  further  back 
there  was  seen  a small  mass,  which  had  a livid  tint,  and  was 
nearly  black ; the  globe  was  much  injected,  but  not  enlarged, 
and  a sanious  discharge  exuded  from  the  surface.  On  the  18th 
of  June  the  organ  was  removed,  and  on  the  20th  of  July  the 
patient  was  doing  quite  well. 

The  general  appearance  of  the  eye  is  well  shown  in  Fig.  36. 
The  interior  of  the  globe  is  filled  with  a dark  brown,  moder- 
ately firm  substance,  and  the  sclerotic  coat  being  traceable  to 
a considerable  extent,  there  is  seen  externally  to  it  a thick 
mass,  which  has  almost  a scirrhous  hardness,  and  is  of  a whitish 


332 


APPENDIX. 


color,  with  some  intermixture  of  brown ; the  Qptic  nerve  is 
much  enlarged,  and  similarly  diseased. 

Dr.  George  A.  Bethune. 

944.  Change  of  color  of  the  hair.  From  an  old  gentleman,  in  his 

eighty-sixth  year.  For  a long  time  his  hair  had  been  perfectly 
white,  as  shown  in  the  smallest  of  two  locks  that  have  been 
preserved.  His  health  having  been  failing  for  some  time,  it 
was  observed  about  a month  before  his  death  that  some  of  his 
hairs  had  turned  black  in  their  whole  length ; of  this  change 
there  is  a specimen  in  the  largest  lock.  Behind  the  ears,  on 
each  side,  was  a lock  that  was  entirely  black,  but  elsewhere 
the  white  and  black  hairs  were  mingled,  as  in  the  specimen. 
The  change  occurred  within  a very  few  days,  and  within  a 
week  of  this  time  the  eyes  changed  from  a blue  grey  to  a dark 
grey  color,  this  last  being,  it  was  said,  their  natural  color  when 
he  was  a child.  1842.  Dr.  James  Jackson. 

945.  Imperforation  of  the  small  intestine  (Fig.  29.)  The  patient 
was  a finely  developed  infant,  and  lived  for  three  days, 
vomiting  most  of  the  time  ; the  case  occurred  in  the  practice 
of  Dr.  George  Hubbard.  For  the  first  thirty-seven  inches  the 
intestine  was  greatly  distended,  measuring  in  some  parts,  on 
being  inflated,  one  inch  and  a quarter  in  diameter,  and  contain- 
ing a considerable  quantity  of  brownish  red  liquid,  but  very  little 
if  any  trace  of  mucus  or  bile ; it  then  terminated  abruptly  in  a 
cul  de  sac.  Below  this,  the  small  intestine  was  directly  continu- 
ous with  the  dilated  portion,  measured  seventy-two  inches  in 
length,  and  was  about  two  and  a half  lines  in  diameter  when 
distended.  The  large  intestine  measured  twenty-one  inches, 
and  from  three  to  four  lines  in  diameter ; both  of  these  por- 
tions were  filled  with  thick  mucus,  which  was  generally  color- 
less, but  in  many  parts  had  a decidedly  yellow  tinge.  Six 
or  seven  inches  below  the  imperforation  there  adhered  to  the 
intestine  a reddish  fleshy  body,  somewhat  larger  than  a pea, 
and  having  upon  the  surface  a cretaceous  deposit  such  as  was 
found  upon  the  diaphragm  (No.  946.)  Otherwise,  the  organs 
were  well  formed.  In  the  preparation,  a portion  of  the  intes- 
tine, having  been  distended  and  dried,  has  been  cut  open  to 
show  the  imperforation.  1847. 


APPENDIX. 


333 


946.  A cretaceous  deposit  from  the  peritoneal  surface  of  a new 
born  infant  (No.  945.)  It  appeared  as  a very  conspicuous  ob- 
ject upon  the  under  surface  of  the  diaphragm,  and,  with  one 
exception,  which  has  been  referred  to  in  connection  with  the 
last  specimen,  it  was  found  in  no  other  part.  This  deposit 
consisted  of  a number  of  opaque,  white,  irregular  crusts,  the 
largest  being  about  two  lines  in  diameter,  and  all  of  them  con- 
nected with  the  peritoneum  by  a veiy  delicate  membrane.  One 
of  the  crusts  having  been  examined  by  Dr.  John  Bacon,  Jr.,  was 
found  to  he  uncrystallized,  and  to  consist  of  about  equal  parts 
of  the  carbonate  and  phosphate  of  lime.  In  the  preparation, 
the  peritoneum  has  been  stripped  off  from  the  diaphragm,  and 
dried  upon  a black  board  ; a small  portion  of  intestine  show- 
ing the  fleshy  body  above  referred  to,  with  the  cretaceous  de- 
posit, has  also  been  preserved. 

947.  A deposit  of  the  phosphate  of  ammonia  and  magnesia  upon 
the  peritoneal  surface,  the  preparation  consisting  of  a portion 
of  the  membrane,  which  has  been  stripped  off  and  dried. 
From  a dissecting-room  subject;  a middle-aged  man,  who, 
from  the  appearance  of  the  intestines,  must  have  died  about 
the  fifth  or  sixth  week  of  typhoid  fever.  On  opening  the  ab- 
domen, the  viscera  seemed  to  be  almost  universally,  though 
slightly  adherent,  and,  on  separating  them,  the  surface  was  at 
once  observed  to  be  roughened,  like  fine  sand-paper. 

A portion  of  this  membrane  was  sent  to  Dr.  John  Bacon,  Jr., 
and  the  following  is  the  result  of  his  examination.  The  de- 
posit appears  in  the  form  of  white,  and  firmly  adherent 
grains.  Under  the  microscope,  it  is  seen  to  consist  partly  of 
isolated  prismatic  crystals  scattered  over  the  surface,  the  largest 
• not  exceeding  the  one-hundredth  of  an  inch  in  diameter ; they 
are  semi-transparent,  and  become  colored  in  polarized  light, 
the  faces  being  considerably  modified,  and  not  well  defined, 
and  the  forms  very  similar  to  those  in  which  the  triple  phos- 
phate occurs.  There  are  also  seen  little  masses,  composed  of 
radiating  acicular  crystals  ; these  .are  more  opaque,  a few  be- 
ing entirely  so,  and  showing  no  crystalline  structure.  The 
two  forms  of  deposit  agree  in  the  reactions  which  they  afford, 
and  consist  of  the  phosphate  of  ammonia  and  magnesia,  as  in 
the  cases  reported  by  Dr.  Robert  Harrison,  in  the  Dublin 


334 


APPENDIX. 


Journal,  for  May,  1836.  (Am.  Joum.  Med.  Science,  Vol.  XX. 
p.  207.) 

No.  502  was  from  the  same  subject. 

948.  Encephaloid  disease  of  the  testicle.  The  patient  was  a per- 
fectly healthy  looking  infant,  aged  three  months,  and  had  no 
hereditary  tendency  to  carcinoma,  so  far  as  could  be  ascer- 
tained. When  it  was  eight  days  old,  the  mother  noticed  an 
enlargement  of  the  organ,  and  from  that  time  it  has  been  in- 
creasing in  size  but  without  any  pain.  August  7,  1847,  it  en- 
tered the  hospital,  and  on  the  11th  the  organ  was  removed  by 
Dr.  Henry  J.  Bigelow.  A few  weeks  previously  it  had  been 
punctured,  and  discharged,  by  report,  blood  and  water.  The 
sense  of  fluctuation  was  veiy  strongly  marked,  and  after  its 
admission  into  the  hospital,  the  growth  was  considerable,  and 
the  surface  became  discolored,  which  it  had  not  been  before. 
The  organ  was  greatly  enlarged,  measuring,  after  its  removal, 
two  and  a quarter  by  one  and  a half  inches ; and  presented  a 
fair  specimen  of  encephaloid  disease  ; cord  healthy. 

• 

949.  A hen’s  egg,  about  the  size  of  a small  olive  ; it  is  well 

formed,  and  the  shell  is  fully  developed,  but  of  the  yolk  there 
was  only  a trace.  1845.  Dr.  Henry  J.  Bigelow. 

950.  The  cranium  and  trunk  of  a malformed  fcetus ; mounted. 
The  cranium  differs  from  any  of  those  already  described ; the 
frontal,  parietal  and  occipital  bones  are  very  imperfectly  devel- 
oped, but,  instead  of  flaring  outwards,  they  rise  perpendicu- 
larly from  the  base  of  the  skull,  and  give  to  the  cavity  a horse- 
shoe form  ; the  posterior  portion  of  the  occiput  consisting  of 
two  pieces  which  are  widely  separated.  The  trunk  is  pre- 
served on  account  of  a strong  lateral  curvature  of  the  spine, 
and  a narrowing  of  the  right  side  of  the  thorax,  several  of  the 
last  ribs  upon  this  side  lying  in  close  contact  with  the  spine ; 
the  sixth,  seventh  and  eighth  ribs  are  fused,  the  second  wants 
its  cartilage,  and  the  sternum,  which  is  very  short,  is  con- 
nected with  the  first  three  ribs  only.  Upon  the  left  side  the 
cavity  of  the  thorax  is  well  developed,  and  the  sternum  is  con- 
nected with  the  usual  number  of  ribs.  The  skeleton  was 
otherwise  well  formed,  and  the  extremities  were  therefore  re- 
moved. 


APPENDIX. 


335 


In  the  recent  state,  the  fcetus  was  sufficiently  developed  for 
the  age.  The  cavity  of  the  cranium  was  entirely  open,  and 
contained  a small  quantity  of  brain,  from  the  base  of  which 
several  of  the  nerves  were  traced.  The  parietes  of  the  abdo- 
men were  almost  entirely  wanting,  and  to  some  extent  those 
of  the  thorax  ; the  liver,  stomach,  small  and  large  intestines, 
kidneys  and  left  testicle  lying  completely  exposed.  The  heart 
was  covered  only  by  its  pericardium.  The  whole  peritoneal 
surface  and  the  left  pleural  cavity  were  inflamed,  and  the 
lung  much  compressed.  There  was  fissure  of  the  uvula,  as  in 
so  many  of  the  acephalous  foetuses ; the  gall-bladder  and 
ducts  contained  a very  little  colorless  secretion  ; the  renal  cap- 
sules were  nearly  or  quite  as  large  as  in  a well-formed  fcetus  ; 
the  left  umbilical  artery  was  wanting ; organs  otherwise  not 
remarkable. 

The  mother  was  a respectable,  young  married  woman,  and 
this  was  her  first  child ; no  cause  assigned  for  monstrosity. 
Labor  occurred  at  about  the  eighth  month,  and  was  easy ; 
head  presented  ; quantity  of  liquor  amnii  large  ; the  cord  was 
only  a few  inches  in  length,  doubled  upon  itself  and  adherent, 
and  broke  in  the  delivery  ; placenta  exceedingly  large.  Child 
still-born,  though  the  motions  had  been  felt,  as  so  often  hap- 
pens, only  a few  hours  before.  Sex  male.  1847. 

Dr.  Asa  B.  Snow. 

951.  Tuberculous  disease  of  the  spinal  marrow.  It  was  situated 
opposite  the  sixth  cervical  vertebra,  and  involved  almost  the 
entire  substance  of  the  organ  at  that  part,  forming  an  opaque, 
yellowish,  solid,  well  defined  and  uniform  mass  about  as  large 
as  the  top  of  the  little  finger ; spinal  marrow  somewhat  en- 
larged at  the  seat  of  disease,  and  a little  softened  just  above 
and  below  it,  but  elsewhere  quite  healthy.  The  membranes, 
also,  were  healthy,  except  for  some  thickening  of  the  dura 
mater  at  the  upper  part.  In  the  preparation  a portion  of  the 
organ  is  shown,  cut  open  longitudinally.  In  the  brain  there 
was  a copious  effusion  of  serum,  with  complete  softening  of 
the  septum.  Extensive  tuberculous  disease  was  found  in  both 
lungs  and  in  the  intestines,  besides  similar  disease  in  the  pros- 
tate gland,  and  in  the  kidneys. 

The  patient  was  an  Irish  laborer,  forty-two  years  of  age,  and 


336 


APPENDIX. 


died  at  the  Massachusetts  General  Hospital,  Sept.  25,  1842. 
Health  quite  good  previously  to  the  last  year,  and  since  then 
no  local  trouble  except  a disease  of  the  ankle  joint.  The 
symptoms  of  spinal  disease  came  on  about  three  and  a half 
months  before  death,  and,  when  examined  on  the  13th  of 
August,  were  as  follows  : diminished  sensation,  with  hardly  a 
trace  of  voluntary  motion  in  the  lower  extremities,  the  upper 
being  very  much  less  affected  ; veiy  frequent  and  involuntary 
contractions  of  the  right  lower  extremity,  tending  to  draw  the 
limb  up  into  a strongly  flexed  position,  and  attended  with  very 
severe  pain ; some  contractions  also  of  the  left  lower  ex- 
tremity, but  without  pain.  Even  on  moving  the  bed-clothes, 
the  muscles  of  the  lower  extremities  would  be  strongly  ex- 
cited, and,  on  attempting  to  straighten  them  when  they  were 
drawn  up,  his  suffering  was  very  great.  In  the  upper  ex- 
tremities these  spasms  were  very  much  less.  The  bladder 
was  completely  paralyzed,  so  that  the  catheter  had  been  used 
daily  for  the  last  three  weeks.  These  symptoms  continued 
with  but  little  change  until  his  death,  the  spasms  being  on  one 
occasion  so  violent  that  the  patient  was  fairly  jerked  out  of 
bed,  and  fell  upon  the  floor,  though  fortunately  with  but  little 
injury.  He  suffered  much  also  from  a morbid  sensibility,  and 
from  neuralgic  pains  in  the  right  lower  extremity,  passing  up 
into  the  abdomen.  Respiration  was  carried  on  by  the  dia- 
phragm, the  intercostal  muscles  being  paralyzed.  The  cathe- 
ter was  used  until  the  last  month,  after  which  the  urine  became 
involuntary ; the  dejections,  also,  were  for  the  most  part  in- 
voluntary, whenever  procured,  the  bowels  being  very  costive. 
The  spine  was  often  examined,  but  the  patient  scarcely  ever 
allowed  any  pain  or  tenderness  there,  neither  was  there  any 
trouble  in  the  head  worth  mentioning.  When  first  seen  his 
general  aspect  was  sufficiently  well,  but  as  the  disease  ad- 
vanced, he  became  exceedingly  emaciated,  and  for  some  time 
before  death  was  veiy  much  sunken,  with  sloughs  about  the 
sacrum.  As  to  his  pulmonary  disease,  he  had  no  symptoms 
that  led  to  a suspicion  of  it ; there  was  occasionally  some 
dyspncea,  but,  as  it  was  generally  accompanied  with  a feeling 
as  of  a cord  about  the  lower  part  of  the  chest,  it  was  attributed 
to  the  paralysis  ; the  nurse,  on  being  questioned  after  the  death 
of  the  patient,  mentioned  an  occasional  very  slight  cough 
during  the  last  few  days,  but  never  before. 


APPENDIX. 


337 


952.  The  seventh  cervical  vertebra,  from  which  the  spinous  pro- 

cess was  broken  off,  and  removed  by  an  operation  two  years 
and  three  months  before  death  ; for  the  history  of  the  case, 
see  specimen  No.  141.  From  the  time  the  above  history  was 
given,  the  power  of  motion  somewhat  increased,  and  the  cramps 
diminished,  but  without  any  other  change  in  the  condition  of 
the  patient,  until  the  last  fortnight,  when  he  was  attacked  with 
diarrhoea,  of  which  he  died  on  the  19th  of  September.  On 
dissection,  the  space  left  in  the  canal  by  the  removal  of  the 
spinous  process  was  found  to  be  filled  by  dense  fibrous  sub- 
stance ; the  theca  adhered  posteriorly  for  a small  extent  to  the 
vertebras,  and  internally  to  the  arachnoid  membrane,  by  slight, 
filiform  attachments ; there  was  also  some  serous  effusion,  but 
otherwise  the  membranes  were  healthy.  The  spinal  marrow, 
having  been  removed  to  the  extent  of  several  inches,  appeared 
healthy,  except  just  at  the  seat  of  injury,  where  there  was 
found,  in  its  centre,  a cavity  about  the  size  of  a pea,  and  filled 
with  serum,  the  surrounding  substance  being  completely  dis- 
organized. The  vertebra  is  seen,  in  the  preparation,  to  be 
uninjured,  except  for  the  loss  of  its  spinous  process  and  a por- 
tion of  the  laminae,  the  upper  half  of  the  ring  being  entire. 
1847.  Dr.  John  B.  Walker. 

953.  Indian  Skull ; dug  up,  with  a considerable  part  of  the  skele- 

ton, in  making  an  excavation  near  the  city  for  the  Brookline 
branch  of  the  Worcester  railroad,  and  presented  to  the  So- 
ciety, Sept.  27,  1847,  by  Dr.  H.  B.  Inches. 

954.  A calculus  from  a Neat’s  tongue  ; of  a regular  cylindrical 

form,  with  rounded  ends,  white,  slightly  roughened  upon  the 
surface,  very  heavy,  and  as  compact  as  the  hardest  marble.  It  is 
one  inch  and  two  thirds  in  length,  three  fourths  of  an  inch  in 
diameter,  and,  a portion  having  been  removed  by  Dr.  M.  Gay 
for  analysis,  was  found  to  consist  mostly  of  the  carbonate  of 
lime.  1847.  Dr.  James  W.  Stone. 


43 


INDEX. 


Abdomen.  Deficiency  of  the  parietes,  778,783-4,  819,950;  peritoneal 
surface  inflamed  in  the  last  two. 

Acephalus.  Preserved  entire  in  spirit,  765 ; drawing  of,  757 ; cast,  758, 
762;  skeleton,  759  ; circulation,  760;  intestine  injected,  761,  764,  and 
veins,  763.  Blighted  foetus,  826. 

Acephalous  foetus.  General  description  of  the  first  variety,  with  an  analy- 
sis of  cases,  766  - 74  ; second  variety,  776  - SI ; third,  783  - 8 ; fourth, 
789  - 95.  Preserved  in  spirit,  772  - 3,  779  ; drawings  of,  770  ; osteo- 
logy, 766  - 74,  775,  776  - 81,  783  - 8,  789  - 95,  950  ; similar  malforma- 
tion in  a double  monstrosity,  845,  847  ; case  of  triplets,  773  ; lived  for 
several  days,  774. 

Air  passages.  Foreign  bodies,  436  - 7 ; parasites,  885,  907  ; malforma- 
tion, 845,  456  - 7,  807,  848  ; ossification,  422  - 8 ; old  suicidal  wound  of 
larynx,  428  ; croup,  430  - 1,  468  ; bronchial  polypus,  432  ; ulceration, 
433  - 4. 

Amputation.  Changes  which  occur  in  the  bones,  185,  189  - 90,  220, 
273  -5.  Natural  stump  in  a frog,  928  - 9 ; in  the  human  subject,  930. 

Anchylosis,  of  the  vertebras,  122,  130  - 3;  hip -joint,  206  - 7,  937; 
knee,  247  - 9,  941;  ankle,  276,  292  - 3,  942;  tarsus,  295  - 6,  299; 
ossified  cartilages  of  the  larynx,  428.  False  anchylosis  of  the  knee- 
joint,  318. 

Aneurism,  of  the  aorta,  367  - 70,  372  - 4;  common  carotid,  376;  sub- 
clavian, 375.  Dissecting  aneurism,  366- 7 ; dilatation,  371;  oblitera- 
tion of  vessels  where  they  arise  from  the  sac,  372  ; bones  affected,  128, 
937  ; ulceration  of  oesophagus,  373  ; fibrinous  clot  in  bronchus,  to  pre- 
vent a rupture,  372;  sloughing  of  external  surface,  without  rupture, 
374,  937.  Rupture  into  the  pericardium,  and  involving  the  pulmonary 
artery,  368  ; into  the  left  primary  bronchus,  372-3;  into  the  lung,  128. 

Aorta.  Impervious  at  its  origin,  340  ; arises  from  right  ventricle,  336. 
Communication  between  two  aortas,  in  a double  foetus,  836,  844,  848  ; 
division  of  a single  aorta,  845,  847 ; union  of  two  aortas,  850.  Lace- 
ration of  aorta,  366  ; rupture  into  pericardium,  from  chronic  disease, 
364-5.  See  Aneurism. 


340 


INDEX. 


Appendix  Cceci.  Unusual  length,  459  ; foreign  bodies  from,  513,  527. 
Inflammation  and  perforation,  511  - 3 ; recovery  from,  499;  cause  of 
internal  strangulation,  498  - 9. 

Arteries.  See  Aneurism.  Injected  preparations,  323  - 5 ; supernumerary 
from  the  arch,  344,  339,  342,  766,  819.  Umbilical  artery  distinct  from 
the  aorta,  757,  762 ; absence  of  one,  766,  783  - 5,  819,  835,  878,  950. 
Right  subclavian  passes  behind  the  oesophagus,  345.  Origin  from  the 
pulmonary  artery,  778.  Inflammation,  361  ; coagulum  after  amputation, 
360.  Ossification,  362-3. 

Articulations.  See  Anchylosis  and  Dislocations.  Ligaments  of  shoulder 
and  knee  joints,  304  - 5 ; relaxation  of  ligaments  of  pelvis  during  ges- 
tation, 722-3;  false  joint  between  exostoses,  153,  156;  loose  bodies 
from  knee-joint,  311,  and  from  a ganglion,  312  - 3 ; fleshy  excrescen- 
ces from  knee-joint,  314-6.  Bursa  containing  fibrinous  masses,  309  ; 
greatly  thickened,  310.  Change  in  the  form  of  the  articulation  from 
mechanical  causes,  297,  250  ; wound  of  knee-joint,  old  and  recent,  940. 
Chronic  disease  of  the  shoulder-joint,  167,  174-5;  elbow,  186,  and 
neighboring  parts,  187;  hip,  201-5;  knee,  242-6;  ankle,  276,  293. 

Arsenic.  Effect  in  preventing  decomposition,  455. 

Atrophy.  Of  the  bones  ; interstitial,  from  old  age,  22,  89,  224  ; from  dis- 
use, 229,  297-8,  185,  189-90,  220,  273  ; and  from  disease,  77,  202, 
293,  168,  277,  290  ; of  the  femur,  in  anchylosis  of  the  hip-joint,  hut 
not  interstitial,  206  ; of  the  occiput,  S7.  Of  the  spleen,  584  ; kidney,  591. 

Biliary  Calculi.  From  the  gall-bladder,  567-72;  ducts,  562;  abscess 
in  the  liver,  563 ; encephaloid  mass  in  the  region  of  the  gall  - bladder, 
564  ; discharged  from  the  bowels,  565;  from  the  umbilicus,  566. 

Biliary  Ducts.  Spiral  valve  of  the  cystic,  551 ; parasites  from,  908  ; dila- 
tation, 556-7,  561;  obstruction  by  calculi,  561,  556;  ulceration,  556  ; 
opening  into  the  pancreatic,  557,  576. 

Blighted  Ovum.  Retained,  751-2. 

Brain  and  membranes.  Formed  independently  of  the  spinal  marrow,  785, 
7S8 ; fibrous  structure,  388;  in  the  acephalous  foetus,  766  - 74,  775, 
776-81,  783-8,  789-95;  development  of  the  pituitary  gland,  766 -74, 
776,  778,  793;  tubercle,  389-90.  Development  of  pia  mater  in  an 
acephalus,  762,  and  in  the  acephalous  foetus  766-74 ; serous  effusion  in 
monstrosities.  804  - 7.  Dura  mater  ; anatomy,  381 ; ossification,  382-5  ; 
tumor,  386.  Meningitis,  following  the  closure  of  a fistula,  109. 

Breast.  Development  during  gestation,  724  ; cancer,  685. 

Bronchial  glands.  Ossification,  446  ; abscess  opening  into  the  oesophagus, 
447. 

Cancer.  See  Malignant  Disease. 

Caries.  Of  the  vertebrae,  112-3,  115-9,  124-5;  sternum,  145-6; 


INDEX. 


341 


lower  fragment  of  a fractured  femur,  236.  Of  an  ossified  cartilage,  427  ; 
aortal  valve,  352. 

Casts  in  plaster.  A collection  of  thirty-two,  presented  by  Dr.  Nathan  R. 
Smith  of  Baltimore,  915. 

Cephahehmaloma.  Tumor  over  the  occiput ; pericranium  ossified,  745. 

Chinese  paintings.  A collection  of  twenty-eight,  presented  by  Dr.  Robert 
W.  Hooper,  913. 

Cholesterine.  In  a gall  stone,  565;  in  various  organs,  667. 

Club  foot.  Casts  of  915  ; frequent  occurrence  in  monstrosities,  757,  762, 
773,  778,  784,  788  ; condition  of  the  bones,  297. 

Cranium.  See  National  Shulls.  Anatomy  of,  11,  13,  7 ; varieties,  28,  43; 
56,  59  ; 30,  63,  952.  Malformation,  in  the  acephalus,  757;  acephalous 
fcetus,  766  - 74,  775,  776  — 81,  783  - 8,  789  - 95,  845, 950 ; in  case  of  ex- 
ternal hydrocephalus,  803  -6,  808  ; in  case  of  deficiency  of  the  extremi- 
ties, 812,  817,  814;  blighted  fcetus,  830;  the  result,  perhaps  of  me- 
chanical cause,  879  ; fusion  of  two  crania,  837,  S44,  818,  S57.  Old 
fracture,  102-4;  epilepsy,  103-4;  recent  fracture  through  the  base 
of  the  skull,  105-  6 ; old  sabre  wound,  107  - 8 ; a cranium  showing  a 
leaden  ball  in  the  frontal  bone,  and  which  had  been  there  for  twenty- 
five  years,  109  ; atrophy,  22,  87  - 9 , thickening,  84  - 6 ; exostosis,  90  ; 
appearance  that  might  be  mistaken  for  the  closure  of  a trephine  open- 
ing, 94;  result  of  syphilis,  95-6;  cancer,  97;  other  disease,  78,  93, 
386. 

Cuticle.  Original  difference  in  thickness  in  different  parts  of  the  body, 
417  ; continued  over  a serous  membrane,  795,  788. 

Diabetes.  Saccharine  extract  from  the  urine,  646,  648 ; nitrate  of  urea,  647. 

Diaphragm.  Deficiency,  766,  778;  fusion  of  the  two  in  a double  fostus, 
as  in  835  ; hernia  through,  493. 

Dislocation,  of  the  shoulder,  172  -3  ; clavicle,  162  ; hip,  at  time  of  birth, 
200;  vertebrae,  without  fracture,  135;  casts  of,  915;  reduction  fol- 
lowed by  inflammation  of  joint,  172. 

Double  Monstrosities.  Union  by  the  thorax,  834;  skeleton,  835.  Fusion 
above,  and  duplication  below  the  umbilicus : human,  836  ; calf,  839  ; 
pig,  840,  845,  847-8;  Guinea  pig,  841;  chicken,  842;  kitten,  843; 
lamb,  844:  osteology,  835,  837,  844-5,  847  -8.  Duplication  com- 
mencing with  the  head  : fish,  849  ; human,  850  ; lamb,  851,  857  ; kit- 
ten, 852-3;  chicken,  854;  duck,  855;  serpent,  856:  osteology,  857. 
Additional  extremities:  human,  858;  kitten,  859-61 ; chicken, 862 -5  ; 
osteology,  863  -5.  Additional  phalanges,  866  - 71.  Two  eggs  united 
by  a band,  871.  Union  in  the  case  of  fruit  and  vegetables,  872-  4. 

Ear.  Anatomy,  17,  397-9;  fusion  of  two,  externally7,  848,  840-1, 
851 ; malformation  internally,  844  ; polypus,  400  : caries,  401-3. 


342 


INDEX. 


Eburnation,  of  the  articular  surfaces,  203,  229,  245. 

Epiglottis.  Absence  of,  807 ; destroyed  by  ulceration,  433. 

Exostosis,  of  the  cranium,  90,  104  ; antler  of  a deer,  91 ; lower  jaw  of  a 
cod-fish,  92;  vertebree,  122,  124,  129-32;  vertebrae  of  a horse,  133; 
scapula,  159  ; humerus,  171 ; carpus  of  a sheep,  196  ; os  innominatum, 
197;  femur,  213-5;  patella,  251  ; tibia,  287  ; fibula,  289  ; tarsus,  294  ; 
tarsus  of  a horse,  299.  Ivory  exostosis,  90 ; fibrous,  159,  197.  Result 
of  a blow,  171 ; of  fracture,  104,  153,  268. 

Extra-uterine  gestation.  Foetus  removed  through  the  parietes  of  the  abdo- 
men, having  been  carried  seven  years,  and  the  woman,  meanwhile,  hav- 
ing borne  three  living  children,  714.  Foetal  bones  removed  by  an  opera- 
tion from  the  urinary  bladder,  715.  Cyst  filled  with  foetal  bones,  from  a 
sheep,  716.  Tubular  pregnancy  ; external  hcemorrhage  observed  as  a 
symptom,  711 ; ova  retained  in  the  oviduct  of  a fowl,  712,  and  in  the 
ovary  of  a striped  basse,  713. 

Extremities.  Remains  ofa  Guanche  Indian,  935;  an  Egyptian,  936.  Ab- 
sence of  one  or  more,  819;  in  the  acephalus,  762,  765;  blighted  foetus, 
826-  7 ; consists  of  a foot,  816  ; a single  finger,  757-62  ; a toe,  816  ; 
an  undeveloped  humerus  and  femur,  818  ; ulna  formed  without  the  hu- 
merus, 757,  and  the  humerus  without  the  ulna,  816  ; absence  of  the  ra- 
dius in  an  adult  subject,  823;  feet  and  hands  fully  developed,  the  ex- 
tremities being  otherwise  imperfect,  814,  812,  809.  Blood  vessels  and 
nerves  developed,  when  the  extremity  is  wanting,  762.  Additional  ex- 
tremities, phalanges,  &c.,  858-71,  809.  Distortion,  778,  794,  87S, 
819,  822,  826.  Fusion  of  fingers,  833  ; Finger  torn  off,  307-8  ; skin 
and  nail  torn  off,  411.  See  Club-foot. 

Eyes.  Undeveloped,  S07  ; two  in  one  orbit,  853,  848;  fusion,  857,  854, 
824  - 5.  Ossification,  393  -4  ; malignant  disease,  395  -6,  943. 

Fallopian  tube.  Absence  of  one,  819 ; formed  independently  of  the  uterus, 
802  ; old  adhesions,  as  observed  in  prostitutes,  665 ; dropsy  of,  666 ; 
cholesterine  from,  667 ; tubercular  disease,  668 ; ovum  developed  in, 
711. 

Feigned  disease.  Pieces  of  bone  from  the  nostrils  and  ears,  934  ; strips  of 
ligamentum  nuchse  from  the  vagina,  671. 

Femur.  See  Articulations , Dislocation,  and  Anchylosis.  Of  a child,  9 ; 
sections,  19;  changes  in  old  age,  213;  after  amputation,  220  ; fracture, 
221-41 ; exostosis  about  the  neck,  mistaken  for  united  fracture,  214; 
inflammation  208  - 9 ; exostosis,  215  ; curvature  just  above  the  condyles, 
216;  malignant  disease,  217  - 9. 

Foetus.  Series  to  show  the  development,  725-43  ; osteology,  1 - 8 ; cir- 
culation, 321  - 3 ; injection  of  skin,  406,  and  intestine,  453  ; cuticle,  417  ; 
development  of  stomach,  450 ; coecum,  451,  and  bladder,  602.  Kirrono- 
sis,  744,  802;  cephalheematoma,  745  ; cretaceous  deposit  upon  the  peri- 


INDEX. 


343 


toneal  surface,  946  ; ulceration  of  the  stomach,  795;  softening,  as  by 
the  gastric  juice,  457. 

Foreign  substances.  From  the  alimentary  canal,  522-33;  air  passages, 
435-7;  nostrils,  934;  urinary  organs,  609-  12,  634,  715;  vagina, 
670-1;  integument,  933. 

Fractures.  Of  the  cranium,  102-6;  vertebrae,  136-43,951;  scapula, 
160-1;  clavicle,  163-4,  166;  humerus,  176-84;  radius  and  ulna, 
192-5;  pelvis,  198,  938;  femur,  221-41;  patella,  252-3;  tibia  and 
fibula,  261  -9,  271  -2,  288  ; metatarsus  of  a deer,  300.  Casts  in  plaster 
of,  915.  Fractures  in  birds,  111,  193,  238 -41,  176  - 9,  271,  301  - 2 ; in 
a tortoise,  157;  in  a crab,  158.  Partial  fracture,  152;  165,  269-701 
into  the  joints,  180-1,  235;  excision  of  the  bone,  181 ; removal  of  a 
fractured  spinous  process,  952;  gun-shot  injury,  199,  222  ; spontaneous, 
219,  230,  223 ; 224  1 changes  in  the  interior  of  old  fractured  bones, 
234,  262  ; strength  of  united  fracture,  267 ; lateral  union,  192,  264-6; 
union  in  case  of  rickets,  77 ; ununited  fracture,  182  - 4,  22S  - 9,  237, 
252-3,  301;  absorption  of  lower  fragment,  184;  caries  of  the  lower- 
fragment,  236  ; disease  of  the  joints  with  old  fracture,  245  - 6,  174 ; 
separation  of  dead  bone,  in  compound  fracture,  235. 

Gall  bladder.  Wanting  in  a fcetus,  802 ; in  an  adult,  552 ; lumbricus  from, 
882  ; filled  with  calculi,  558-  9 ; calculi  adherent,  560  ; dilatation,  554  ; 
ulceration,  556 ; opening  into  the  colon,  565  ; ossification,  555 ; atrophy, 
553  ; encephaloid  disease,  564. 

Gangrene.  Extensive  gangrenopsis,  with  recovery,  83  ; of  the  lungs, 
441 ; of  the  lungs  and  Peyer’s  patches  in  typhoid  fever,  500  ; of  the 
bladder  in  fracture  of  the  spine,  604 ; of  the  appendix  caeci,  from  a for- 
eign body,  511  - 3 ; of  the  extremities,  from  ossification  of  the  arteries, 
363  ; from  paralysis  and  other  causes,  930. 

Hair.  Change  of  color  in  old  age,  944  ; from  an  Albino  negro,  421  ; 
from  a naevus  upon  the  scalp,  420  ; formed  in  cysts,  678-81,  924-5. 

Hare-lip.  Single,  in  a fcetus  of  two  or  three  months,  831 ; condition  of 
the  bones  in  a fcetus,  832  ; double,  847,  807. 

Heart.  Anatomy,  321  - 3,  326  - 7.  Malformation;  absence  in  the  aceph- 
alus,  757,  762  ; foramen  ovale  open,  328-31,  334,  336  ; interventricu- 
lar opening,  332-6,  339,  341,  836,  850;  right  ventricle,  332-6,  and 
deficiency  of  the  pulmonary  valves,  332-5,  in  interventricular  opening  • 
death  from  hcemorrhage,  332,  334  ; one  ventricle  undeveloped,  the  other 
quite  large,  340,  342  ; ductus  arteriosus  open,  343,  332  ; protrusion  ex- 
ternally, 784,  950.  In  a double  fcetus  : a single  organ,  845  ; a fusion  of 
two  organs,  834-  5 ; two  separate  organs,  836,  844,  848,  850.  Wound, 
346;  fibrinous  deposit,  357  ; polypiform  mass,  358;  dilatation,  353-4; 
aneurism,  355;  tubercles,  356,581;  valvular  disease,  347-52;  coro- 
nary artery  ossified,  359. 


344 


INDEX. 


Humerus.  See  Articulations  and  Dislocation.  Anatomy,  9,  10,  19 ; frac- 
ture, 174,  176-84;  after  amputation,  185;  absorption  of  cartilage, 
167 ; hyperostosis  in  a partridge,  170 ; exostosis,  171 ; result  of  old 
disease,  probably  caries,  169. 

Imperforate  Anus , 460-1,  757,  802,  87S ; minute  opening  from  the  rec- 
tum into  the  urethra,  in  male  subjects,  as  a general  rule,  460 ; opening 
of  the  intestine  into  the  vagina,  466 ; into  the  bladder,  773. 

Imperforate  Rectum , 462-  5 ; dilatation  of  intestine,  463  ; vagina  wounded 
in  an  operation  for,  465. 

Intestine.  See  Imperforate  Anus,  and  Rectum,  Internal  Strangulation, 
Intussusception,  Typhoid.  Fever,  Payer's  Glands,  and  Appendix  Cceci. 
Anatomy,  451-3  ; situated  as  in  early  foetal  life,  784,  7S8 ; imperfora- 
tion  of  jejunum,  945  ; upper  portion  wanting  in  the  acephalus,  757,  762 ; 
diverticula,  458.  762,  791,  844-5,  S50.  Dilatation,  in  a double  foetus, 
before  the  division  of  a single  intestine,  836,  S45  ; before  the  fusion  of  a 
double  set  of  intestines,  850.  Protrusion  from  a deficiency  of  the  abdom- 
inal parietes,  950,  778-9,  783-4,  819;  at  umbilicus,  848,  757,  765, 
807.  Parasites  : lumbrici,  880,  883  ; echinorynehi,  890-2  ; taenia;,  893, 
900;  bothriocephalus,  901, 903  ; linguatula,906.  Foreign  bodies,  527-33. 
Chyle  in  the  villosities,  485.  Fatty  dejections,  in  a case  of  disease  of  the 
pancreas,  576.  Rupture  from  violence,  485  ; perforation  in  a fish,  by 
parasites,  S92  ; hernia  of  the  mucous  membrane  of  the  duodenum,  486, 
and  of  the  large  intestine,  508  ; polypus,  487.  Acute  inflammation  in 
dysentery,  514;  ileus,  515  ; the  result  of  obstruction,  464,  518,  perfo- 
ration occurring  in  the  last  case.  Chronic  ulceration  of  duodenum,  with 
perforation,  506;  of  large  intestine,  516-7;  rectovaginal  fistula,  675, 
519  ; opening  into  a fistula,  in  case  of  disease  of  the  spine,  117  ; open- 
ing from  a mesenteric  abscess,  541  ; discharge  of  a tubular  membrane, 
505.  Malignant  disease  : of  the  small  intestine,  with  abrupt  dilatation, 
507  ; of  the  large  intestine,  518-20. 

Intussusception.  At  the  junction  of  the  small  and  large  intestines,  488  - 92  ; 
of  the  rectum,  509. 

Kidneys.  Absence  of  both,  802;  of  one,  757;  protrusion  of,  from  defi- 
ciency of  the  abdominal  parietes,  950;  fusion,  585,  781,  787  ; lacera- 
tion, 578  ; inflammation,  586  ; tubercular  disease  ; renal  phthisis,  592  ; 
disease  in  dropsy,  590.  Encysted,  587  - 9 ; in  a monstrosity',  788,  810  ; 
congenital  in  589  and  652  ? Atrophy,  591 ; from  dilatation  of  the  pel- 
vis, 598-9;  malignant  disease,  593-4.  Pelvis  dilated,  597- 9 ; dis- 
tended by  strongyli,  598  ; inflamed,  605.  Ureters  imperfectly  developed, 
788;  two  upon  one  side,  785,  794  ; divided,  795  ; dilated,  599-601,773. 

Kirronosis.  744,  802. 

Lower  jaw.  Imperfectly  developed,  816  ; single  in  a “ double-headed 
foetus,”  857,  848  ; additional  development,  844  ; shot  away,  110;  caries 
in  a mink  and  skunk,  79,  80  ; necrosis,  82  ; malignant  disease,  98  - 100. 


INDEX. 


345 


Liquor  amnii.  Profuse  discharge,  in  cases  of  acephalous  foetus,  766  - 74, 
778,  784,  950  ; in  a case  of  spina  bifida,  798. 

Liver.  Wanting  in  the  aeephalus,  757,  762  ; irregular  development,  781, 
783,  788  : two  organs  in  a double  foetus,  844  ; fusion  of  the  two,  835, 
850:  protrusion  from  a deficiency  of  the  parietes,  778,  783-4,  819 
950.  Laceration,  and  yellowness  of  the  surface,  as  a sign  of,  545  ; cica- 
trization, 550;  abscess,  549;  tubercular  disease,  548 ; cirrhosis,  546-7. 

Lizard.  Bifid  tail,  931. 

Lungs.  Wanting  in  the  aeephalus,  757,  762;  imperfect,  or  irregular 
development,  766,  781,  783  — 4,  788,  845,  848,850;  protrusion  of,  from 
a deficiency  of  the  parietes,  784.  Emphysema,  438;  apoplexy,  439, 
457  ; gangrene,  441  ; spurious  melanosis,  440;  arrest  of  tubercular  dis- 
ease, 442  ; carcinoma,  358. 

Malignant  disease.  Of  the  bones,  97  - 8,  101,  148,  217-  9,  230  ; antrum, 
101  ; shoulder,  914;  thigh,  926;  ankle  joint,  317;  eye,  395-  6,  943; 
lungs,  358;  oesophagus,  471-2,479;  stomach,  479-84;  small  intes- 
tine, 507;  large  intestine,  518-20;  pancreas,  573-4;  gall-bladder, 
564;  kidneys,  593-4;  prepuce,  708;  testicle,  693,  695,  948-694? 
Congenital,  185;  in  young  subjects,  948,  695,  507  ; abscesses,  in  con- 

f 'nection  with  disease  of  the  ribs,  148. 

Mastodon.  Animal  matter  in  the  bones  and  teeth,  26. 

Melanosis,  of  the  eye,  396,  943  ; spurious,  of  the  lung,  440. 

Mesentery.  Imperfect  development,  781  ; cyst.icercus  from,  in  a sheep, 
905 ; mass  of  concrete  chyle,  378  ; abscess,  opening  into  the  intestine, 
541.  Ossified  glands,  542  ; tumor,  543. 

Nails.  Fusion,  833.  Hypertrophy,  418-9. 

National  Skulls.  From  Scio,  39  ; Maltese,  40  ; French  soldier  from  Malta, 
41;  Egyptian,  with  most  of  the  skeleton,  42;  two  Theban,  43-4; 
from  the  Ganges,  45-8;  Chinese,  49-51;  Celebes  Islander,  52; 
Sandwich  Islander,  53-8  ; African,  59-61 ; North  American  Indian, 
from  the  New  England  States,  62-7,  953;  from  the  Columbia  river, 
68-9;  cast  of  a Carib  head,  70;  from  California,  71-2.  Peruvian; 
Inca  race,  73  - 5 ; ancient  race,  76. 

Necrosis,  of  the  lower  jaw,  82  ; sternum,  147  ; tibia,  276,  942,  and  follow- 
ed in  the  last  case  by  anchylosis  of  the  knee  and  ankle  joints  ; os  calcis, 
303.  Sequestrum  from  the  ulna,  191  ; femur,  210  - 1 ; tibia,  279  ; exfo- 
liation from  the  femur  after  amputation,  212  ; portion  of  the  upper  max- 
illary bone  thrown  off  in  case  of  gangrenopsis,  83;  portions  of  the  hyoid 
bone  expectorated,  435. 

Nerves.  Maxillary,  14.  Formed  independently  of  the  brain  and  spinal 
marrow,  766  - 74,  776  ; and  also  of  the  extremity  which  they  are  to  sup- 
ply, 762  ; ganglia  of  the  sympathetic  nerve  large  in  an  aeephalus,  762. 
44 


346 


INDEX. 


Nostrils.  Rudimentary  in  an  acephalus,  757  ; imperfectly  developed  in  an 
acephalous  foetus,  807.  Polypus,  404-5. 

Oesophagus.  Opening  into  the  larynx  and  trachea,  845  ; lower  portion 
opening  into  trachea,  the  upper  terminating  in  a cul  de  sac,  456-7. 
Dilatation,  469;  contraction,  the  effect  of  an  alkali,  470.  Malignant 
disease,  471,  479  ; opening  into  the  trachea,  472. 

Ossification.  Of  the  cartilages  of  the  ribs,  306 ; larynx  and  trachea, 
422-6;  gall-bladder,  555;  pericardium,  320  ; pleura,  448-9;  valves 
of  the  heart,  347-50,  352;  arteries,  362-3;  fibrin  upon  the  inner  sur- 
face of  the  heart,  357,  and  in  the  veins,  380  ; bronchial  and  mesenteric 
glands,  446,  542;  renal  capsules,  595;  dura  mater,  382-5;  eye, 
393-4;  spleen,  579-80;  testicle,  688-9;  placenta,  749;  fibrous 
tumors,  661  - 2 ; upon  the  inner  surface  of  a dilated  kidney,  598,  and  in 
the  fat  about  the  kidney,  932  ; cretaceous  deposit  upon  the  surface  of 
the  diaphragm,  946,  and  upon  the  ovary,  676.  Caries  of  an  ossified 
cricoid  cartilage,  427  ; aortal  valve,  352. 

Osteosarcoma.  Of  the  thigh,  217  - 18. 

Ovary.  Absence  of  one,  819  ; situated  in  the  groin,  652  ; surface  smooth 
after  puberty,  the  uterus  being  impervious,  652  ; corpus  luteum,  721. 
Cretaceous  deposit  upon  the  surface,  676  ; encysted  disease,  677  - 81. 
Malignant  disease,  683  ; 682,  and  684? 

Palate.  Condition  of  the  bones  in  fissure,  806,  812,  845,  847  - 8,  781 ; 
deceptive  appearance  of  fissure  in  the  acephalous  foetus,  788.  Fissure  of 
the  uvula  in  the  acephalous  fetus,  776,781,  783,  788,  950;  trace  of,  795. 

Pancreas.  Absence  of,  in  the  acephalus,  757,  762  ; cavity  in  the  organ 
filled  with  blood,  557;  malignant  disease,  573-4;  calculi,  575-6. 
Duct  dilated,  575-6,  557  ; obliterated  at  its  opening  into  the  intestine, 
557,  576  ; opening  into  the  hepatic  duct,  557. 

Parasites , 880-913.  Lumbrici,  880-  3;  anatomy,  881  ; large  number 
from  a child,  880  ; from  an  epileptic  dog,  883  ; from  the  gall-bladder, 
882,  and  from  the  ducts,  908.  Filariae,  from  the  integuments,  884 ; air 
tubes  of  a porpoise,  885  ; peritoneal  cavity  of  a horse,  887  ; from  beneath 
the  peritoneum  of  a fish,  888.  Strongyli  from  the  kidney  of  a mink, 
889.  Echinorynchi  from  the  intestine  of  a hog,  890,  and  fish,  892. 
Taeniae  from  the  human  subject,  893  - 99  ; from  a porcupine,  900.  Bot- 
riocephalus,  901-3.  Cysticercus  cell,  from  the  human  subject,  904  ; 
from  a sheep,  905.  Linguatulae  from  the  intestine,  and  from  the  lung  of 
a serpent,  906-7.  Distoma  hep.  from  an  elephant,  908.  Trichina 
spiralis,  909.  Chondracanthus  from  the  mouth  of  a whiting,  910.  Bot- 
fly ; larvae  from  the  stomach  of  a horse,  911,  and  from  the  frontal  sin- 
uses of  a sheep,  912. 

Pelvis.  Anatomy,  9,  19  ; imperfect  development,  816,  S20,  812  ; relaxa- 
ation  of  ligaments  during  gestation,  722-3  ; fracture,  19S,  938;  gun- 
shot wound,  199;  fibrous  exostosis,  197. 


INDEX. 


347 


Penis.  Anatomy,  701  - 2 ; absence  of  the  frsenum  in  a negro,  703;  hy- 
pospadias, 704 ; venereal  warts,  705  ; destroyed  by  venereal  disease, 
707 ; cancer,  708. 

Pericardium.  Deficiency,  781  ; pneumopericardium,  363  ; adhesion,  319, 
347-8  ; ossification,  320;  rupture  into,  364-5,  368. 

Peritoneum.  Parasites  from  the  cavity,  887  ; inflammation  in  monstrosi- 
ties, from  a deficiency  of  the  parietes,  819,950;  cretaceous  and  crys- 
talline deposite,  676,  946-7  ; carcinoma,  544. 

Peyer's  Glands.  Redness  during  the  process  of  digestion,  454,  and  in  acute 
disease,  430,  504.  Inflammation  in  typhoid  fever,  500-  1;  in  dysen- 
tery, 503. 

Pharynx.  External  fissure  below  the  jaw,  844  ; ulceration  in  scarlatina, 
468  ; constriction  from  the  cicatrisation  of  venereal  ulcers,  467. 

Placenta.  Injected,  746;  ossification,  749;  encysted,  778;  tumor  in, 
750  ; a small  portion  adherent,  747  ; the  whole  mass  adherent  to  the 
uterus,  and  causing  a sloughing  of  the  fundus,  748. 

Pneumothorax,  443-4. 

Polypus.  Of  the  nose,  404-5  ; ear,  400  ; intestine,  487  ; womb,  654-5, 
718. 

Prostate  Gland.  Enlarged,  696-8.  Calculi  in  situ,  699 ; removed  and 
analyzed,  700. 

Pulmonary  Artery.  Two  valves,  333,  335,  835;  four  valves,  337-8; 
valves  imperfect  in  interventricular  opening,  332-5;  impervious  at  its 
origin,  342;  arises  from  aorta,  339,  341  ; gives  origin  to  the  right  ca- 
rotid and  subclavian  arteries,  778.  Opening  into  a tubercular  cavity, 
445  ; involved  in  aneurism  of  the  aorta,  368  ; haemorrhage  from,  into  a 
tubercular  cavity,  445. 

Radius  and  Ulna.  Anatomy,  9,  10,  19;  radius  wanting  in  an  adult,  823  ; 
fracture  of  both  bones,  192-3,  and  of  one,  194- 5 ; changes  after  ampu- 
tation, 190;  disease,  connected  with  scrofulous  ulcers,  188;  seques- 
trum, 191. 

Renal  Capsules.  Independent  of  the  kidneys,  802,  757.  Small  in  the 
acephalous  foetus,  766-74,  776,  781,  783,  789,  793-5;  sufficiently 
developed,  785,  788,  950  ; small  in  another  form  of  monstrosity,  807 ; 
fusion,  762.  788.  Encysted  disease,  596  ; ossification,  595. 

Ribs.  Thirteen  pairs,  4 ; bifurcation,  34  ; fusion  and  other  anomalies  in 
monstrosities,  762,766-74,  778,780-1,783-5,788,  844,950;  757, 
762,  778,  789,  847.  Fracture,  152-4,  160  ; exostosis,  156;  lateral 
union,  155  ; carcinomatous  deposit,  148. 

Rickets.  Changes  in  the  skeleton,  77. 

Rhinencephalous  Pig,  824  -5. 

Sacrum.  Open  posteriorly,  33  ; malformation,  801;  curvature,  104;  ca- 
ries, 124-5. 


348 


INDEX. 


Salivary  Calculus,  954. 

Scapula.  Anatomy,  9,  38  ; fusion  of  two,  845  ; fracture,  150-1. 

Skeleton.  FoEtal,  1-5;  adult,  12 ; of  monstrosities,  759,  766,776-8 
781,  783-4,  786,788-9,812,  814,  820,  835,  837,  844-5,  847,  863-5, 
950  ; of  a child  affected  with  rickets,  77. 

Skin.  Injected,  406  ; tanned,  407-8  ; tattoed,  409-10  ; torn  from  finger, 
with  the  nail,  411 ; excrescences,  412  ; models,  &c.  of  disease,  413-16. 

Spina  bifida.  Preparations  of  the  soft  parts,  796,  801-2;  osteology, 
797-9,  789,  847 ; unusual  form,  800-2  ; in  an  acephalous  fcetus,  789  ; 
in  a double  pig,  847  ; complicated  with  hydrocephalus,  798  ; in  a patient 
sixteen  years  of  age,  the  spinal  marrow  terminating  at  the  fourth  dorsal 
vertebra,  799  ; death  from  meningitis,  796. 

Spinal  Marrow.  Formed  independently  of  the  brain,  757 ; deficiency  or 
absence  in  the  acephalous  foetus,  766-74,  776-8,  781,  783-5,  788-9, 

847  ; prolongation  in  spina  bifida,  802  ; from  a case  of  backward  curva- 
ture of  the  spine,  392 ; tubercle,  951 ; cartilaginous  deposit  in  the  arach- 
noid, 391. 

Spleen.  Structure,  577 ; wanting  in  the  acephalus,  757,  762  ; lobulated, 
811  ; protrusion  from  a deficiency  of  the  parietes,  784,  950;  laceration, 
578  ; ossification  upon  the  surface,  579-80  ; tuberculous,  581  -2  ; pe- 
culiar disease,  with  analysis  of  cases,  583  ; atrophy,  584. 

Sternum.  Sections,  19;  imperfectly  developed,  950;  consists  of  two 
lateral  portions,  757,  762  ; perforation  in  the  adult,  36-7, 151 ; episternal 
bones,  35  ; union  of  the  two,  in  a double  fcetus,  835.  Fracture,  149  - 50  ; 
laceration  of  the  substance  between  the  bones,  151;  caries,  145-6; 
necrosis,  147  ; carcinomatous  deposit,  148. 

Stomach.  Development,  450  ; wanting  in  the  acephalus,  757,  762  ; form 
irregular,  781  ; fusion  of  the  two  organs  in  a double  foetus,  S36,  844-5, 

848  — two  organs  separate,  850 ; protrusion  from  a deficiency  of  the 
parietes,  784,  950.  Larvae  of  the  bot-fly,  911  ; foreign  substances, 
522-6;  fatal  haemorrhage,  from  the  rupture  of  a vessel  without  ulcera- 
tion, 575  ; effects  of  elaterium,  473.  Chronic  ulcer,  474-8  ; perforation 
in,  475-6;  hemorrhage  in,  477;  hemorrhage  and  perforation  in,  478. 
Malignant  disease,  479 -S4. 

Strangulation  of  the  intestine.  By  a band  of  false  membrane,  494-5  ; by 
a diverticulum,  496-7;  by  the  appendix  cseci,  498-9;  diaphragmatic 
hernia,  493;  occurrence  of  previous  attacks  important  in  diagnosis,  498. 

Teeth.  Anatomy,  14,  534-5  ; animal  matter  in  the  mastodon,  26  ; three 
upper  incisors  upon  one  side,  75  ; development  in  an  acephalus,  757  ; 
preternatural  growth  of  the  incisors  in  a marmot,  537-S;  incrusted 
with  tartar,  539  ; disease,  540. 

Testicle.  Absence  of,  6S6  ; protrusion  from  a deficiency  of  the  parietes, 
950  ; organs  fully  developed,  the  external  appearances  being  those  of  a 


INDEX. 


349 


female,  807.  Ossification,  688-9  ; scrofulous  disease,  690-1 ; fungous, 
692  ; malignant,  693,  695,  948  ; 6941  Yas  deferens  wanting,  757. 

Thymus  Gland.  Absence  of,  in  an  acephalus,  762.  Enlargement,  927. 

Thyroid  Gland.  Ossified  cyst  from,  429. 

Tibia  and  Fibula.  Anatomy,  9,  19;  fracture,  261-9,  271-2,  288; 
changes  after  amputation,  273-5;  sequestrum,  279;  exostosis,  289, 
287.  Disease  in  connection  with  old  ulcer  of  the  leg,  254  - 9 ; 260  ? ca- 
ries, 278  ; necrosis,  279,  276;  scrofulous  disease,  277,  290- 1 1 syphi- 
litic, 280-5;  fungous  growth,  286;  result  of  former  disease  of  tibia 
and  ankle  joint,  293. 

Tumors.  Adipose,  916-18;  glandular,  919;  scirrhous,  920;  cellular, 
921;  encysted,  922-4.  Paintings  of,  913-4. 

Tunica  Vaginalis.  Inflammation,  139  ; ossific  body,  687  ; cast  in  plaster 
of  hydrocele,  667. 

Typhoid  Fever.  Disease  of  Peyer’s  glands,  500  - 1 ; haemorrhage  from  an 
ulcer,  510;  occurrence  of  intussusception,  492 ; crystals  upon  the  mu- 
cous membrane,  and  in  the  cavity  of  the  intestine,  502. 

Umbilical  Cord.  Forty-five  inches  in  length,  755  ; very  short  sometimes 
in  monstrosities,  762,  778,  784,  821,  950  ; knot  in  the  cord,  756. 

Umbilical  Vesicle.  At  about  the  sixth  week,  729. 

Urinary  Bladder.  Development,  602  ; peculiar  form,  603  ; thickened  and 
dilated  in  a monstrosity,  the  urethra  being  impervious,  773  ; imperfectly 
developed,  the  kidneys  being  wanting,  802;  sacculated,  606,  696-8, 
the  sac  being  larger  than  the  bladder  itself  in  606 ; inflammation  and 
gangrene  in  fracture  of  the  spine,  604 ; chronic  disease,  the  result  of 
calculus,  605  ; fungous  excrescences,  607  ; carcinoma,  608. 

Urinary  Calculi.  Formed  upon  a broken  catheter,  611  ; quill,  612  ; sus- 
pender buckle,  634  ; sealing  wax,  642.  Composed  of  uric  acid,  613  - 16, 
620  ; uric  acid  and  urates,  617-19  ; urate  of  ammonia,  639 ; uric  acid  and 
the  mixed  phosphates,  622-3  ; urate  of  ammonia  and  the  mixed  phos- 
phates, 638  ; uric  acid  and  the  urates,  with  the  mixed  phosphates,  624  ; 
urate  of  ammonia  and  oxalate  of  lime,  626  ; phosphate  of  lime,  630,  627, 
632  ; phosphate  of  lime  and  the  urates,  628-9  ; mixed  phosphates,  634-7  ; 
mixed  phosphates,  with  a nucleus  of  oxalate  of  lime,  641 ; with  a nu- 
cleus of  urate  of  ammonia  and  uric  acid,  640  ; oxalate  of  lime,  644 ; 
oxalate  of  lime,  with  a thin  crust  of  uric  acid,  643  ; xanthic  oxide  upon 
a calculus  of  the  phosphate  of  lime,  632  ; triple  phosphate  deposited 
from  the  urine,  633.  Urine  of  a serpent,  625.  Calculi  from  the  kidney, 
618,  621,  626,  645;  from  the  ureter,  to  which  it  wras  adherent,  630; 
passed  from  the  urethra,  613,615,  631-2,644,637;  from  under  the 
prepuce  of  a hog,  637  : the  rest  were  from  the  bladder.  Removed  by  an 
operation,  623-7,  629,  642.  From  a case  of  fractured  spine,  638-9. 

Uterine  Hydatids , 753-4. 


350 


INDEX. 


Uterus.  Relations  to  the  other  pelvic  organs,  649 ; imperfect  develop- 
ment, S19;  consists  of  three  cavities,  that  open  into  the  bladder,  773 ; 
divided  by  a septum  throughout,  650  ; fundus  divided,  718  ; bilobated, 
651,  with  other  malformations,  652.  Gravid  at  an  early  period,  709, 
729  ; third  month,  710  ; full  period,  717.  Anatomy  of  the  decidua,  709  ; 
729.  Rupture,  718-9,  805.  Sloughing  of  the  inner  surface,  after  a te- 
dious labor,  720  ; of  the  fundus,  from  a retention  of  the  placenta,  74S. 
Hernia,  652;  prolapsus,  656;  inversion,  653;  polypus,  654-5,  718. 
Fibrous  tumors,  657-63;  injected,  and  shows  the  enlargement  of  the 
blood-vessels,  657  ; development  of  the  muscular  structure,  660  ; disor- 
ganization, 659-60  ; ossification,  661  -2  ; cause  of  abortion,  659.  Ma- 
lignant disease,  663-4,  675. 

Vagina.  Absence  of,  652,  457,  S02  ; longitudinal  septum,  650  - 1 ; band 
across  the  outlet,  669;  foreign  bodies  from,  670-  1;  elephantiasis  of 
the  external  organs,  672-4  ; ulceration,  opening  into  the  rectum,  519. 

Veins.  Absence  of  valves  in  the  acephalus,  763,  757  ; left  subclavian  and 
jugular  open  into  the  right  auricle  separately  from  the  upper  vena  cava, 
457.  Inflammation,  377 ; inferior  vena  cava  distended  by  fibrin,  37S ; 
iliac  vein,  after  recovery  from  inflammation,  379  ; phlebolites,  3S0. 

Vertebral.  Anatomy,  9,  19;  transverse  process  developed  to  represent  a 
rib,  844 ; spinal  column  in  the  acephalus,  759,  762,  in  the  acephalous 
foetus,  766-74,  775,  776-81,  7S3-S,  789-95,  and  in  spina  bifida,  797-9, 
SOI,  S47  ; fissure  of  the  bodies  of  the  vertebrae,  7S0-1  ; fusion  of  two 
spinal  columns  in  a double  monstrosity,  845,  847,  849-50.  Fracture  of 
the  cervical  vertebrae,  136-7;  dorsal,  138,  140,  142-3;  lumbar,  139; 
spinous  process  removed  by  an  operation,  952  ; partial  recovery,  952, 
142  - 3 ; formation  of  urinary  calculi,  142  - 3 ; dislocation,  without  frac- 
ture, 135;  obscure  injury,  144.  Caries  without  curvature,  112,  113, 
124-5,  128,  937,  the  two  last  being  the  result  of  aneurism;  with 
curvature,  116-19;  intervertebral  substance  primarily  affected,  117;  a 
second  invasion  of  caries,  117  ; opening  of  a fistula  into  the  intestine, 
117 ; recovery,  with  complete  anchylosis,  114,  120-1  ; occurrence  in  a 
case  of  spina  bifida,  799  ; symptoms  of  phthisis  in  case  of  extensive  ca- 
ries, 115  ; lateral  curvature  of  the  spine  of  a pickerel,  from  an  absorption 
of  one  of  the  vertebra;,  123.  Atlas  separated  into  two  lateral  halves, 
126  ; separation  of  the  wings  from  the  body  of  a lumbar  vertebra,  127. 
Exostosis  from  the  edges  of  the  vertebra,  resulting  in  anchylosis,  130-3. 

Vomiting.  Fatal,  as  a symptom  of  pregnancy,  710,  and  note  to  729. 


EXPLANATION  OF  THE  FIGURES. 


Fig.  1. 

“ 2. 
“ 3. 

“ 4. 

“ 5. 

“ 6. 

“ 7. 

“ 8. 


“ 9. 

11  9'. 


“ 10. 
“ 11. 
“ 12. 
“ 13. 
“ 14. 


K 


15. 


11  16. 

“ 17. 

“ 18. 

“ 19. 

“ 20. 
“ 21. 

“ 22. 

“ 23. 


PI.  I.  No.  329.  Foramen  ovale  open  in  the  adult. 

PI.  I.  No  330.  The  same. 

PL  I.  No.  331.  The  same. 

PI.  III.  No.  759,  Skeleton  of  a monstrosity  (acephalus.) 

PI.  III.  No.  766.  Skeleton  of  an  acephalous  fetus;  a.  a.  the  frontal 
bones  ; b.  b,  the  posterior  portions  of  the  occiput. 

PI.  III.  No.  775.  The  posterior  portion  of  the  occiput  of  an  acephalous 
fetus. 

PI.  IX.  No.  844.  Lower  jaw  of  a double  lamb,  showing  additional 
alveoli  and  teeth  beneath  the  symphisis. 

PI.  III.  No.  780.  Spine  of  an  acephalous  fetus;  a.  a fissure  through 
the  bodies  of  the  cervical  vertebrae;  b.  an  additional  wing  upon  the 
body  of  the  eleventh  dorsal  vertebra. 

PLY.  No.  781.  Skeleton  of  an  acephalous  fetus;  a.  a.  rudimentary 
parietal  bones. 

PL  V.  No.  781.  A front  view  of  the  upper  portion  of  the  spine,  show- 
ing an  extensive  fissure  through  the  bodies  of  the  vertebrae ; a.  the  cen- 
tral opening;  b.  union  of  the  body  of  the  third  cervical  vertebra  with 
that  of  the  seventh  dorsal,  upon  the  left  side  ; c.  union  of  the  bodies  of 
the  second,  third,  fourth  and  fifth  cervical  vertebrae  with  that  of  the 
eighth  dorsal  upon  the  right  side. 

Pl.  IV.  No.  783.  Skeleton  of  an  acephalous  fetus;  posterior  view; 

a.  a.  the  posterior  portions  of  the  occipital  bone:  b.  b.  tne  parietals. 

PL  IV.  No.  783.  A lateral  view  of  the  skeleton  last  referred  to  ; a.  the 

posterior  portion  of  the  occipital,  and  b.  the  parietal  bone. 

PL  IV.  No.  784.  Skeleton  of  an  acephalous  fetus;  a.  a.  the  parietal 
bones  ; b.  b.  the  posterior  portions  of  the  occiput ; c.  c.  the  frontal  bones. 

PL  VI.  No.  785.  External  view  of  an  acephalous  fetus,  the  brain  being 
developed,  but  situated  outside  of  the  cranial  cavity. 

PL  VII.  No.  786.  A posterior  view  of  the  skeleton  of  the  monstrosity 
last  referred  to  ; a.  a.  the  frontal,  and  b.  b.  the  parietal  bones ; c.  c.  the  pos- 
terior portions  of  the  occiput ; d.  the  temporal,  and  e.  the  styloid  process 
of  the  temporal  hone ; f.  the  malar,  g.  the  nasal,  h.  the  ungual,  i.  the 
superior  maxillary,  and  j.  the  inferior  maxillary  bones  ; k.  an  additional 
wing  connected  with  the  ninth  dorsal  vertebra. 

PL  VII.  No.  786.  A lateral  view  of  the  skeleton  of  the  monstrosity  last 
referred  to  : l.  a fusion  of  the  wings  of  the  cervical  vertebra  ; m.  m.  the 
wings,  and  n.  n.  the  bodies  of  the  vertebra.  The  other  letters  corres- 
pond with  those  in  the  last  figure. 

PL  V.  No.  788.  Skeleton  of  an  acephalous  fetus  ; a.  the  frontal,  and 

b.  the  parietal  bones  ; c.  the  posterior  portion  of  the  occiput. 

PL  V.  No.  788.  Fusion,  with  irregular  development  of  three  of  the  ribs, 
from  the  skeleton  last  referred  to. 

PL  VIII.  No.  793.  Cranium  of  an  acephalous  fetus;  a.  the  posterior 
portion  of  the  occiput  ; b.  the  frontal,  and  c.  the  parietal  bones. 

PL  VIII.  No.  808.  Cranium  of  a monstrosity. 

PL  VIIT.  No.  812.  Cranium  of  a monstrous  calf. 

PL  VIII.  No.  837.  Base  of  the  skull,  with  a portion  of  the  skeleton  of 
a double  fetus. 

PL  X.  No.  836.  Stomach  and  portion  of  the  intestine  of  the  double 
fetus  last  referred  to. 

PL  IX.  No.  849.  A double  fish. 


352 


EXPLANATION  OF  THE  FIGURES. 


Fig 

24. 

PI. 

X. 

No.  846. 

25. 

PI. 

X. 

No.  850. 

(( 

26. 

PI. 

I. 

No.  896.  1 

“ 

27. 

PI. 

IX. 

No.  826. 

f( 

23. 

PI. 

IX. 

No.  827. 

C< 

29. 

PI. 

I. 

No.  945.  I 

(( 

30. 

PI. 

I. 

No.  612.  I 

It 

31. 

PI. 

II. 

No.  770. 

(C 

32. 

PI. 

II. 

No.  770. 

u 

33. 

PI. 

X. 

No.  845. 

view 

of  the  same 

(C 

34. 

pi. 

X. 

No.  845. 

Alimentary  canal  of  a double  fcetus. 
reenia  sol.  showing  a great  irregularit 
A blighted  foetus. 

A second  blighted  fcetus. 


Sketch  of  an  acephalous  fcetus  ; front  view. 

A side  view  of  the  same. 

Fusion  of  the  scapulae  of  a double  foetus.  33'.  Another 


Figures  7.  23.  30.  31.  and  32.  it  should  be  remarked,  have  been  added  since  the 
text  was  prepared  for  the  press,  and  the  figure  of  specimen  No.  943,  which  it  was 
intended  to  introduce,  has  been  omitted. 


ERRATA. 

Page  214,  19th  line  from  top;  for  “bladder,”  read  “ vagina.” 

“ 3,  9th  line  from  bottom,  for“  frontal,”  read  parietal.” 

Page  1,  Sth  line  from  bottom,  for  an  intermaxillary  read  a maxillary. 

“ 9,  last  line,  for  are  read  were. 

“ 12,  Sth  line  from  the  top,  for  109  read  120. 

“ 37,  14th  line  from  the  top,  for  in.  read  iv.  ; and,  upon  the  45th  page,  for  iv 
read  v. 

“ 66,  7th  line  from  the  top,  for  anchyloted  read  anchylosed. 

“ 216,  9th  line  from  the  top,  for  509  read  507. 

“ 258,  19th  line  from  the  bottom,  for  10  read  9r. 

“ 261,  3d  line  from  the  bottom,  for  7S7  read  786. 

“ 263,  and  266,  for  254  read  260. 

“ 269,  12th  and  21st  line  from  the  bottom,  omit  (No.  789.) 

“ 2S5,  2d  line  from  the  bottom,  for  810  read  S09  ; and  on  the  236tb  page,  for 
810,  S12  and  811,  read  809,  Sll  and  S10. 

302,  last  line,  for  23  read  7. 

“ 305,  llth  line  from  the  bottom,  for  mounted  read  not  mounted. 

“ 309,  17th  line  from  the  top,  for  26  read  25. 


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